十二指腸脂肪腫の1例

A Case of Duodenal Lipoma

　十二指腸良性腫瘍は比較的まれな疾患とされており¹⁾⁴⁾⁵⁾，現在まで，本邦では100余例の報告をみるにすぎない．その大部分は腺腫であり，脂肪腫は本邦では極めて少なく現在までの報告例は2例のみである¹⁾³⁾．われわれは最近，胆石症の症例で術前に施行した経皮的肝内胆造管影により十二指腸下行脚にポリープ様陰影を認め，手術により十二指腸脂肪腫であった1例を経験したので若干の考察を加えて報告する，

　The patient, a sixty-five-year-old woman, was admitted complaining of slight fever and general fatigue. Laboratory examination on admission was within normal limits. After admission, she had little appetite and slight fever. Alkaline phosphatase was elevated to 36.7 K. A. U. The abdomen was distended and slight pain on pressure was recognized in the right hypochondrium, but no tumor was palpable. Percutaneous trashepatic cholangiography disclosed a round shadow defect in the gallbladder, as well as adefect in the second portion of the duodenum caused by the tumor. Hypotonic duodenography also revealed that the tumor was smooth and clearly demarcated in contour. Duotdenofiberscope showed a spherical protruded mass at the upper region of the ampulla of Vater, which showed an erosion on its surface. She was preoperatively diagnosed as both cholelithiasis and duodenal polyp. At operation the anterior wall of the second portion of the duodenum was opened, where the tumor was detected. It seemed to have originated from the submucosa, since the mucosa was intact. This tumor was 2 cm in diameter, smooth on the surface and soft in consistence. It was conically removed. Histologically it was submucosal lipoma composed of adipose tissue cells. Cholecystectomy was performed because there were two cholesterin stones in the gallbladder. Duodenal lipoma, particularly in Japan, is very rare; only twocases have been reported so far.