下血にて発症した小腸GIST（uncommitted type）の診断にvirtual endoscopyが有用であった1例

Usefulness of Virtual Endoscopy in the Diagnosis of GIST (uncommitted type) of the Small Intestine Initially Manifested by Melena, Report of a Case

要旨　症例は49歳，女性．主訴は浮遊感．貧血と下血にて紹介入院となった．下部消化管内視鏡検査（CF）にて大腸と回腸末端部に新鮮血を認めたが，病変は認めなかった．小腸の検索のため，CFにて腸管内に送気されているためCF直後に腹部3D-CTを行った．長径約9cmの腫瘍を認め，virtual endoscopy（VE）にて腫瘍の一部が回腸内腔に突出し，その頂部に陥凹を認めた．以上より，回腸の粘膜下腫瘍および同部位からの出血を疑い，出血が持続したため同日に手術した．Bauhin弁より口側約50cmの回腸にGIST（uncommitted type）を認めた．小腸から出血を呈した腫瘍の診断にVEが有用であった．

　The patient was a 49-year-old woman with a chief complaint of a “floating” sensation, who was referred to us and admitted because of anemia and melena. Colonofiberscopy (CF) revealed fresh blood in the colon and terminal ileum, but no lesion was detected. Because air had been introduced into the small intestinal tract by CF, 3D-CT of the abdomen was performed immediately after CF in order to examine the small intestine. A tumor with a long diameter of approximately 9 cm was discovered, and virtual endoscopy (VE) revealed that part of the tumor was protruding into the lumen of the ileum and that there was a depression in its tip. Based on these findings, a submucosal tumor of the ileum with bleeding from the site was suspected and, because the bleeding had persisted, emergent surgery was performed on the same day. A gastrointestinal stromal tumor (GIST ; uncommitted type) was found in the ileum 50 cm proximal to Bauhin's valve. VE was useful in diagnosing this tumor manifested by bleeding from the small intestine.