内視鏡的ポリペクトミーにより摘除したS状結腸脂肪腫の1例

Semi-pedunculated Lipoma of the Sigmoid Colon Which Was Success fully Removed by Endoscopic Polypectomy, Report of a Case

　消化管内視鏡器機の進歩とその使用技術の向上，更には安全でコンパクトな高周波発生装置の開発などによって，消化管ポリープの内視鏡的摘除法は長足の進歩を遂げた．われわれも1975年から1979年末までに168例，合計244個の大腸ポリープを内視鏡的に摘除し，ポリープの完全生検診断と治療に努めてきた．

　最近，比較的まれな大腸脂肪腫を内視鏡的ポリペクトミーで，幸運にも偶発症を惹起することなく摘除し，治癒せしめた症例を経験した．大腸脂肪腫の内視鏡的ポリペクトミーを行うにあたっては，常に安全に行えるとは限らず，適応に問題があって，その報告例は極めて少なく，調べえた範囲では本症例も含めて6例7個であった．これらの症例をもとに，大腸脂肪腫の内視鏡的診断や内視鏡的ポリペクトミーの適応などについて考察を加え報告する．

　Recently we experienced a case of lipoma of the sigmoid colon which is relatively rare in Japan. The patient was a 46-year-old woman with the chief complaint of abdominal pain. Radiological and colonofiberscopic examinations led us to establish a diagnosis of submucosal tumor. The tumor was semipedunculated so as to show the peduncle when the tumor was pulled up. With the judgment that colonofiberscopic polypectomy was feasible, various preliminary tests were thoroughly performed and the patient was explained that laparotomy might possibly be required, then colonofiberscopic polypectomy was actually performed. Fortunately the tumor was successfully removed without causing any complication, resulting in a complete cure.

　Although there is a view that colonofiberscopic polypectomy is not suitable for submucosal tumor, this technique seems useful for diagnosis and treatment of such a tumor as long as it is performed by skilled persons with careful considerations for its applicability. However, this should not be attempted easily and aggressively. The matters to be taken into consideration for application of the technique together with discussion were reported in this paper.