術前に診断しえた虫垂粘液囊腫の1例―注腸X線，大腸内視鏡，CT所見について

Appendiceal Mucocele Diagnosed Preoperatively, Report of a Case

要旨　術前に診断しえた虫垂粘液囊腫の1例を報告した．注腸X線検査では盲腸内側下極寄りに外側から半径1.5cmの半円状の陰影欠損がみられ1～2本のひだが同定された．虫垂は造影されなかった．大腸内視鏡検査では同部に半径1.5cmの半球状の黄色調隆起がみられ，隆起表面に全周性にわたり一条のひだがみられた．粘膜面は正常であった．CT検査では回盲部に一致して壁の石灰化を伴った囊胞がみられた．以上の所見より虫垂粘液囊腫と診断，手術を施行した．CT検査で回盲部に壁の石灰化を伴ったcystic massがみられた場合，注腸X線検査および大腸内視鏡検査で盲腸の隆起粘膜表面に円形のひだを同定することが，虫垂粘液囊腫の術前診断には重要である．

　A 47 year-old woman was admitted to the Hakodate Chuo Hospital because of abdominal discomfort. A barium enema study revealed a well defined spherical tissue mass projecting into the cecum inferolaterally with the appendix being not filled. A colonoscopic examination showed the submucosal tumor of the cecum covered with the normal mucosa with a rounded fold on the surface. Computed tomographic (CT) examination revealed ileocecal cystic mass with calcification.

　The preoperative diagnosis was appendiceal mucocele. A resected specimen also revealed the mucinous cystadenoma of the appendix with numerous psammoma bodies.

　When ileocecal cystic mass with calcification is detected by CT examination, the identification of a rounded fold on the surface of the submucosal tumor in the cecum by barium enema studies and colonoscopic examinations is required for the purpose of preoperative diagnosis of an appendiceal mucocele.