回腸脂肪腫に起因する腸重積症の1例

Intussusception of Ileo-cecal Region, Induced by Lipoma, Report of a Case

　消化管の脂肪腫はまれな疾患で，特異的症状を欠くため，術前に診断を下すことは非常に難しく，開腹により発見されることが多いとされている．最近，著者らは，回腸脂肪腫に起因する回盲部腸重積症を経験したので，若干の文献的考察と併せて報告する．

　A man aged 72 was admitted to our clinic, complaining of massive melena and lower abdominal pain. He had been troubled with dyspnea on exertion and tarry stool these four months. On admission, a mobile and fist-sized tumor was palpated in the right lower abdominal quadrant. The x-ray examination by barium enema showed intussusception of ileo-cecal region and an oval tumor of the terminal ileum. The contour of the tumor was smooth and ulceration on the surface was found. The angiography showed that the margin of the tumor was abundant in small vessels, but not the center of it. There were not found the irregularity or the encasement of the vessels ant tumor-staining. The tumor was suspected to be benign by angiogram. The resection of the ileo-ceca: region was performed and the specimen showed a polypoid tumor, 45×43×37 mm in size, at 10 cm oral site from the ileo-cecal valve. There was not found lymph node swelling in the mesentery. The histological finding of the tumor was lipoma of the ileum. Fifty-nine cases of the lipoma of the small intestine have been reported from 1909 to 1979 in Japan and this case is 60th. It is noteworthy that majority of them originated in the ileum and accompanied with intussusception.