内視鏡的憩室切除術を施行したintraluminal duodenal diverticulumの1例

Intraluminal Duodenal Diverticulum (IDD) Treated by Endoscopic Excision, Report of a Case

要旨　患者は26歳，男性．主訴は食後の腹部膨満感，悪心・嘔吐．中学のころより過食後に悪心・嘔吐あり症状が増強したため，1983年6月当科受診．上部消化管造影の結果，十二指腸下行脚内腔に2mmの透明帯によって囲まれた西洋梨状の陰影あり，intraluminal duodenal diverticulum（IDD）と診断された．7月22日内視鏡下で憩室切除術を施行した．吸引によりIDDを口側へ翻転させポリペクトミーと同様の手技でスネアーをIDDの基部にかけ，高周波電流を通電し憩室底を切除した．憩室は両側とも十二指腸粘膜で覆われ粘膜筋板を有していた．IDDは世界で約100例，本邦で26例の報告があり，本邦では内視鏡的憩室切除を施行したのは本例が4例目である．

　A 26 year-old man visited our hospital because of postprandial abdolninal fullness and vomiting with nausea on June 9, 1983. Upper gastrointestinal series revealed a barium filled pear-shaped sac surrounded by a thin radiolucent line in the middle of the second part of the duodeum. He was diagnosed as having intraluminal duodenal diverticulum (IDD). He had no other abnormalities except idiopathic dilatation of the right ventricle. By the endoscopic observation, the diverticulum was attached to the entire circumference of the duodenal lumen and small aperture of IDD was present, but the papilla of Vater could not be recognized. We performed a duodenofiberscopic excision of IDD on July 22, 1983. After the diverticulum was inverted to the oral side by aspiration, polypectomy-snare was placed around the middle of the projected diverticulum, Excision was made by the same maneuver of polypectomy using high frequent electric currents. Histological finding of the excised specimen revealed normal duodenal mucosa on both sides of the sac. After this excision the patient became asymptomatlc.

　IDD is a rare congenital anomaly seen in the second part of the duodenum. The pathogenesis of IDD has been considered due to incomplete duodenal diaphragma, which was extended by the passage of the food and peristals is. As far as we know, 26 cases of IDD including our case has been reported in Japan, Our case is the fourth treated successfully by endoscopic excision which Hajiro et al reported at first in 1979.