出血を主症状とした小腸腫瘍の診断

Diagnosis of Tumors of the Small Intestine with Massive Bleeding

要旨　1980年4月から1991年12月までに当院で手術された原発性小腸腫瘍は28例（悪性リンパ腫11例，癌10例，平滑筋腫瘍5例，脂肪腫2例）であった．発見手段は経口的小腸X線検査20例，血管造影3例，手術5例であった．腹痛などの閉塞症状を有する腫瘍は全例，経口的小腸X線検査にて発見されていた．下血を主症状とした腫瘍は7例（25％）で，平滑筋腫瘍4例，癌2例，悪性リンパ腫1例であった．下血を主訴とし閉塞症状を有さない病変は全例，非上皮性腫瘍で，これらの発見手段は小腸X線検査2例（平滑筋肉腫，悪性リンパ腫各1例）で，残りの3例はいずれも平滑筋腫瘍で血管造影にて発見されていた．閉塞症状を伴わない消化管出血患者の診療においては，管外性に発育した小腸平滑筋腫瘍を念頭に置き検査を進めるべきと考えられた．検査の第1選択としては，経口的小腸X線検査またはゾンデ法小腸X線検査とし，この時点で病変が発見できなかった場合，または急を要する場合には，選択的上腸間膜動脈造影が有効と思われた．

　Twenty eight cases of primary tumors of the small intestine (11 malignant lymphomas, 10 carcinomas, five smooth muscle tumors, and two lipomas) were operated on in our hospital. In twenty cases tumors were detected by barium meal study, in three cases by angiography, and in five cases tumors were not detected preoperatively. In the cases with obstructive symptom, tumors were all detected by barium meal study. There were seven cases (25%) with massive bleeding, including five smooth muscle tumors, two carcinomas, and one malignant lymphoma. In the cases without obstructive symptom, but which were accompanied by bleeding, the tumors were all non-epithelial tumors, two of which were detected by barium meal study, and three of which were smooth muscle tumors, detected by angiography. Smooth muscle tumors of the small intestine with extraluminal growth should be suspected, when there is gastrointestinal bleeding without obstructive symptoms. For the first examination, barium meal study or double contrast study should be performed. When these studies are unsuccessful, or in urgent cases, selective SMA angiography is useful.