口側回腸に輪状潰瘍を合併したMeckel憩室の1例

Meckel's Diverticulum with an Annular Ulcer at Neighboring Ileum, Report of a Case

要旨　患者は57歳，女性．赤黒い血便を主訴として来院上部消化管内視鏡検査，大腸のX線および内視鏡検査では異常を認めず，小腸からの出血を疑い小腸X線検査を施行した．経口小腸造影および有管法による小腸二重造影にて，回盲弁より口側約100cmの回腸に憩室様突出を伴う囊状拡張部，その肛側に狭窄，口側に拡張不全を伴う病変を認めた．^99mTcO₄^-シンチグラフィーでは異常は認めなかった．Meckel憩室の術前診断のもとに回腸部分切除術を施行した．回盲弁より口側約80cmに憩室を伴う囊状に拡張した回腸を認め，同部を含めて近傍回腸は腸間膜および後腹膜に高度に癒着していた．切除標本では憩室は胡桃大，病変部の肛側狭窄部は癒着による単なる捻れであり，口側拡張不全部には全周性の輪状潰瘍を認めた．組織学的には憩室は筋層を有する真性憩室で，異所性組織の迷入は認めず，輪状潰瘍はUl-Ⅱの非特異性単純潰瘍であった．Meckel憩室の診断における種々の検査法，とりわけ小腸X線検査の有用性について述べた．

　A case of Meckel's diverticulum diagnosed preoperatively is presented. A 57 year-old woman visited our hospital with a complaint of melena. A barium enema examination, total colonoscopy and upper gastrointestinal panendoscopy showed no abnormality. X-ray examination of the small intestine by barium meal study and double contrast method after duodenal intubation demonstrated a cystic dilatation with diverticulum-like protrusion at about 100 cm oral from the ileocecal valve. The anal side of the lesion was stenotic and the oral side was narrow. Abdominal scanning with ^99mTcO₄^- revealed no abnormality.

　After the diagnosis of Meckel's diverticulum was established, laparotomy was done. Cystic dilated ileum with Meckel's diverticulum was found at about 80 cm oral from the ileocecal valve and its neighboring ileum showed adhesion to the mesenterium and retroperitoneum. Resected specimen showed a walnut-sized diverticulum. The stenosis of anal portion was due to simple torsion of the ileum by adhesion to the mesenterium and retroperitoneum. The narrow oral portion showed an annular ulcer. Histological examination of the diverticulum revealed true diverticulum having entire ileum structure without ectopic tissue.