病変が横行結腸とS状結腸の2か所に非連続性に及び，かつ横行結腸に膿瘍を合併した腸間膜脂肪織炎の1例

Mesenteric Panniculitis Extending Discontinuously to the Transverse Colon and the Sigmoid Colon, and Associated with Abscess, Report of a Case

要旨　患者は41歳，女性．主訴は発熱，右下腹部痛．CTでは結腸肝彎曲部の嚢胞性腫瘤およびS状結腸壁の肥厚と，これら周辺の腸間膜脂肪織濃度の上昇，少量の腹水を認めた．注腸X線検査ではS状結腸の軽度狭窄と片側性の鋸歯状変化および横行結腸右側の著明な狭窄と辺縁不整像を認めた．横行結腸の病変における肛門側の立ち上がりは比較的なだらかであったが，口側の立ち上がりは急峻であった．内視鏡検査ではS状結腸より口側へ挿入できなかった．以上から横行結腸癌穿孔による膿瘍形成と腹膜播種を疑い，手術を施行した．病理組織学的所見では膿瘍を合併した腸間膜脂肪織炎であり，病変が非連続性に大腸に及んだ極めてまれな症例であった．

　A 41-year old female complained of right lower abdominal pain and fever. The CT scan revealed a large cystic mass around the hepatic flexure of the colon, thickened wall of the sigmoid colon, and increased density areas in the surrounding mesentery, and minimal ascites. Barium enema study demonstrated mild narrowing and unilateral saw tooth-like appearance of the sigmoid colon, and marked narrowing and irregular edge of the transverse colon. In the lesion of the transverse colon, the rise on the anal side was gentle, but its rise on the oral side was steep and looked like an overhanging edge. In colonoscoy, it was hard to insert the instrument into the oral side of the sigmoid colon. We suspected most strongly an advanced transverse colon cancer associated with perforation, abdominal abscess, and pertoneal dissemination. Because of this an operation was performed. The histopathological diagnosis was mesenteric panniculitis associated with subserous abscess in the transverse colon.