虫垂重積を形成した虫垂子宮内膜症の1例

Appediceal Intussusception by Endometriosis, Report of a Case

要旨　患者は63歳，女性．大腸がん検診で便潜血検査陽性を指摘され当センターを受診注腸X線検査では，短縮した虫垂内に芋虫状の細長い大きさ約2cmの隆起性病変を認めた．内視鏡検査では，虫垂入口部には異常所見を認めなかったが，生検鉗子を用いて入口部を広げると，発赤した表面平滑な隆起性病変が蠕動に伴って虫垂口から盲腸に脱出するのが認められた．超音波内視鏡および造影CT検査を行ったが質的診断には至らず，虫垂原発の粘膜下腫瘍であるが，右下腹部の慢性的な鈍痛の原因になりうることや悪性も完全には否定できないと本人および家族に説明し，腹腔鏡下虫垂切除術を施行した．病理組織学的検討から，虫垂体部に発生した子宮内膜症が虫垂重積を来し，それによってポリープ状の粘膜下腫瘍様病変が形成されたものと診断された．

　A 63-year-old woman visited our center because of a positive fecal occult blood test. Barium enema examination revealed an elevated lesion with smooth surface, approximately 20 mm in diameter, like a green caterpillar, in the shortened appendix. Endoscopic examination revealed normal finding concerning the orfice of the appendix, but also an elevated lesion covering the normal mucosa from the opening of the vermiform appendix. Based on the x-ray examination and endoscopic findings, the patient was diagnosed as having a submucosal tumor of the appendix so laparoscopic appendectomy was performed. Immediately previous to operation, diagnosis of appendiceal endometriosis was difficult, so appendectomy was performed with a preoperative diagnosis of appendicitis. Relying on pathological findings, this case was diagnosed as appendiceal intussusception associated with endometriosis. It was concluded that, bearing in mind clinical information and other imaging findings, and considering the circumference of the appendix, appendiceal mass lesions may be correctly diagnosed by barium study, as being cases of intussusception or not.