大腸憩室症とポリープ・癌の併存した2例

Carcinoma or Adenoma in the Segment of Diverticular Disease of the Colon, Report of Two Cases

　S状結腸憩室病の興味ある2例を報告する．1例は憩室に進行癌と早期癌が，1例は憩室とポリープとが，併存した例である．また，当教室での大腸憩室病の最近の傾向についても検討した．

　症　例

　〔症例1〕73歳，男．

　主　訴：便柱が細い，残糞感．

　既往歴：18年前に十二指腸潰瘍で，胃切除術を，13年前に胆囊結石で，胆囊切除術を受けた．

　現病歴：1年前より排便時に，ときに下血あり．近医の診断は内痔核で，坐薬を使用した．下血の回数は減少した．10ヵ月前より，少量の軟便があったと思うと，2，3日すると便秘，という状態を繰り返した．3カ月前からは便柱が細くなり，残糞感が増強した．

　Diverticular disease of the colon was radiologically found in 133 out of 1,384 patients who were referred to the double contrast barium enema examination in the year 1979.

　A single diverticulum was detected in 30 (22.6%) out of the 133 patients and scattered diverticula in 70 (52.6%) of them. The remaining 33 patients were found to have diverticula in cluster.

　In 94 patients under the age 59, diverticula were seen at the right side colon in 85.1%, at the left side colon in 3.2% and at the entire colon in 11.7%. In the other 39 patients over the age 60, diverticula were found at the right side colon in 46.2%, at the left side colon in 28.2% and at the entire colon in 25.6%. These results reveal that diverticular disease of the colon tends to occur at the left side colon in Japanese people over the age 60.

　Out of the 133 patients with diverticular disease of the colon, malignant or benign neoplasma was encountered in or next to the segment of the diverticular disease in 18 patients with 19 lesions (12 carcinomas and 7 adenomas), and neoplasma distant from the segment of diverticular disease was seen in 22 patients with 22 lesions (7 carcinomas and 15 adenomas). There was no significant co-relation between neoplastic development and diverticular disease.

　From the radiological point of view, a diagnosis of neoplasmas in or next to the segment of diverticular disease is often difficult. In our series, neoplasmas n the segment of diverticular disease could be diagnosed by the use of compression method in addition to the routine double contrast barium enema technique.

　Case 1 is a 73 year-old male who had three months history of a small-caliber stool and who also felt residual stool immediately after defecation. He had a barium enema done and was found to have an advanced carcinoma and pedunculated polypoid lesion in the segment of diverticular disease of the sigmoid colon. He had the sigmoid colon resected. A macroscopic and histological examination of the resected specimen showed a type 2 advanced carcinoma (welldifferentiated adenocarcinoma) with the involvement of a submucosal, muscle and subserosal layer and a secondary deposit in the regional lymph nodes and a co-existent adenoma with focal carcinoma in the segment of the diverticular disease.

　Case 2 is a 81 year-old male who had a year history of blood-stained motion with occasional mucus discharge at defection. He was found to have a polypoid lesion with a long stalk in the segment of diverticular disease of the sigmoid colon. The compression method at the barium enema examination clearly visualized a polypoid lesion with a long stalk among the diverticula. The pedunculated polypoid lesion was polypectomized at colonoscopy and a histological diagnosis was a tubular adenoma.