大腸憩室を背景に発生したと考えられるfiliform polyposisの1例

A Case of Filiform Polyposis Developed in the Colon with Multiple Diverticula

要旨　患者は53歳，男性．無症状であったが，胃癌術後経過観察目的のCT検査で上行結腸壁肥厚がみられた．注腸X線検査と大腸内視鏡検査で上行結腸に多発集簇した紐状ポリープと多発憩室がみられ，左側結腸にも憩室が多発していた．経過をみていたところ，次第に腹痛，下痢がみられるようになった．2年後，上行結腸の病変は増大し腸管の伸展不良を伴っており，下行結腸遠位側には非対称性のなだらかな狭小化と粘膜の凹凸不整がみられ，右半結腸切除術が施行された．病理診断はfiliform polyposisであり，多発憩室と壁在膿瘍を伴っていた．1年後イレウスを来して入院した際に下行結腸に高度の狭窄がみられ，再度手術が行われた．病理学的所見は上行結腸の病変に酷似していた．本例は憩室腸管にfiliform polyposisが形成される過程を追跡できた最初の症例であると考えられる．

　An asymptomatic 53 year-old man underwent abdominal computed tomography for postoperative follow-up of gastric cancer, and wall thickening of the ascending colon was demonstrated. Barium enema X-ray and colonoscopy revealed aggregated finger-like projections in the ascending colon and diverticula on the both sides. Two years later, abdominal pain and diarrhea developed and worsened. The lesion in the ascending colon become enlarged and narrowing of the lumen was also observed ; gradual stricture with mucosal irregularity appeared at the distal portion of the descending colon. Right hemicolectomy was performed ; histological diagnosis was filiform polyposis complicated by diverticula and intramural abscess. One year later, he was readmitted due to obstruction of the descending colon and bowel resection was performed again. The stenosis was caused by a lesion similar to the previous one. This case was the first one in which the developing process of filiform polyposis in the colon with multiple diverticula was traced by barium enema X-ray and colonoscopy.