内視鏡的に切除しえたintraluminal duodenal diverticulumの1例

Intraluminal Duodenal Diverticulum Treated by Endoscopic Resection, Report of a Case

要旨　患者は21歳，女性．1989年8月から繰り返す急性膵炎発作を主訴に1991年4月当科受診．上部消化管X線検査で，intraluminal duodenal diverticulumに特徴とされる，周囲に薄い隔壁様の透亮像を有する西洋梨状陰影を認めた．内視鏡検査で，十二指腸管腔内の吸引，送気で移動する憩室を認めた．憩室付着部位とVater乳頭の位置関係から内視鏡的切除可能と判断，ポリペクトミーの手技で切除した．切除標本では，憩室は両面とも十二指腸粘膜に覆われ，粘膜筋板を有していた．このことは本症の発生原因として不完全十二指腸隔膜説を支持する所見であり，急性膵炎の発症原因として本症が関連していたと考えられた．

　A 21-year-old woman was admitted to our hospital with chief complaints of back and abdominal pains. She had noticed these pains since August, 1989. Past and family history was not contributory. Physical examination revealed mild epigastric tenderness only. Upper gastrointestinal x-ray examination disclosed a typical appearance of a barium-filled sack-like structure with surrounding a thin translucent zone in the descending part of the duodenum. Endoscopic examination showed an intraluminal duodenal diverticulum (IDD) in the descending part of the duodenum without other abnormalities. It was resected endoscopically with a polypectomy-snare. The post operative course was uneventful except for mild hemorrhage, and she was discharged without symptoms. The histological examination demonstrated that bilateral sides of the diverticular sack were covered with normal duodenal mucosa, and the muscularis mucosae was seen between them.

　IDD, a rare anomaly of gastrointestinal tract, has been reported more frequently as the progress of endoscopic examination. As far as we know, 41 patients with this disease have been reported in Japan. Our case is the 9th report of IDD treated by endoscopic resection.