成人腸間膜リンパ管腫との鑑別が困難であった両側傍卵巣囊腫の腹腔鏡下切除例

Laparoscopic resection of bilateral paraovarian cysts mimicking lymphangioma : A case report

◆要旨：症例は67歳，女性．腹部超音波検査にて腹腔内囊胞を指摘された．婦人科にて卵巣囊腫は否定的と判断され，当科紹介となった．画像所見では，囊胞は多房性で複数存在し，卵巣からの連続性が不明瞭であったため，腸間膜リンパ管腫が鑑別に挙げられた．増大傾向を認めたため，診断および治療目的に腹腔鏡下手術を施行した．術中，囊胞性病変は両側卵巣に隣接しており，傍卵巣囊腫と診断した．婦人科医と協議のうえ，両側とも腹腔鏡下に摘出しえた．傍卵巣囊腫は比較的稀で，特に高齢女性では卵巣の萎縮により術前診断が困難となる．傍卵巣囊腫は，時に捻転を生じて急性腹症を呈すことがあり，外科医にとっても鑑別上重要な疾患である．他科との連携を含めた的確な対応が求められる．

　A 67-year-old woman was found to have an intra-abdominal cyst on abdominal ultrasonography. An ovarian cyst was ruled out by the gynecologist, and the patient was referred to our department. Imaging studies revealed multiple multilocular cysts. The ovaries could not be clearly identified and their relationship to the cysts was uncertain, raising suspicion of a mesenteric lymphangioma. Due to progressive enlargement, laparoscopic surgery was performed for both diagnostic and therapeutic purposes. Intraoperatively, the cystic lesions were found adjacent to both ovaries and were diagnosed as bilateral paraovarian cysts. In consultation with gynecologists, complete laparoscopic excision was performed on both sides. Paraovarian cysts are relatively rare, and their preoperative diagnosis is particularly challenging in elderly women because of ovarian atrophy. Paraovarian cysts may occasionally undergo torsion and may present as an acute abdomen ; therefore, they should be recognized by surgeons as important differential diagnoses as well. Accurate management, including close collaboration with other specialists, is essential.