消化管出血を起こしたメッケル憩室の1例

A Case of Bleeding Meckel's Diverticulum

　メッケル憩室は最もよく知られた臍腸管奇形であり，人口の1～3％にみられるという¹⁾．これらの多くは無症状に経過するが，15～30％が憩室に起因する症状を呈し²⁾³⁾，最も多い合併症は出血である³⁾．しかし，本症の頻度に対して術前に診断された例は極めて少ない．これは憩室が小腸下部に存在することが最大の障害になっており，最近ではその局在性にとらわれない検査法，すなわち，血管造影やシンチグラフィーによる診断例が増加しつつある．

　われわれは，この数年間，小腸疾患に注目し，小腸二重造影法をはじめとして，積極的に小腸の検索を行ってきたが，今回，下血を主訴とし，各種のX線検査で典型的な所見を呈し，術前に診断しえたメッケル憩室の1例を経験したので報告する．

　A case of bleeding Meckel's diverticulum diagnosed preoperatively is presented. A 22-year-old man visited our hospital with a complaint of melena. A barium-enema examination, gastroduodenoscopy and sigmoid-scopy showed no abnormality. X-ray examination of the small intestine by double contrast method after duodenal intubation demonstrated a diverticulum of the ileum. Barium meal study disclosed mucosal folds which suggested the shadow of gastric rugae in the diverticulum. Abdominal scanning with ^99mTc pertechnetate showed a distinct focus in the left lower quadrant near the bladder. Arterlographic diagnosis of Meckel's diverticulum was made by the demonstration of tortuous, irregular vessels around the diverticulum and pooling of the contrast medium due to the ectopic gastric mucosa in the diverticulum.

　After the diagnosis was established, laparotomy was done. Meckel's diverticulum was found in the ileum at 100 cm orally from the ileocecal valve. The surgical specimen revealed a small ulcer and a polypoid lesion which consisted of the crowded mucosal folds in the diverticulum. Pathological examination revealed hyperplasia of the ectopic gastric mucosa, a small ulcer at the normal ileal mucosa and the submucosal pancreatic tissue.

　The usefulness of various examinations for diagnosing Meckel's diverticulum is discussed.