回盲部病変のX線診断

Radiographic Diagnosis of Ileal and Appendiceal Lesions

要旨●回盲部は解剖学的に複雑な部位であり，内視鏡検査とCTのみでは病変の全体像を把握しにくいことが少なくない．X線造影検査は回盲弁からの距離や虫垂との位置関係などを客観的に把握できるなど，内視鏡検査とCTのみでは得られない術前情報が得られる．特に管腔狭小化合併例や瘻孔形成例においては必須の検査となり，また，管腔外からの浸潤・炎症波及例などにおいても有用となる．本稿では当科における回盲部X線造影検査（注腸造影と経口小腸造影）の撮影手順を紹介し，上行結腸進行癌，リンパ腫，カルチノイド腫瘍，虫垂杯細胞癌，腸管Behçet病，小腸結核，MEFV遺伝子関連腸炎（家族性地中海熱遺伝子関連腸炎）のX線造影所見を内視鏡所見とともに示した．病変の部位，性状に応じたX線造影検査法，撮影法の選択が重要であり，二重造影のみならず充盈像や圧迫像を含めた動的な撮影により重要な情報が得られることがある．

　The ileocecal region is anatomically complex, and obtaining a complete picture of the lesion through endoscopy and computed tomography（CT）alone is often difficult. Fluoroscopy provides preoperative information that cannot be obtained via endoscopy and CT, including the objective assessment of the distance from the ileocecal valve and the positional relationship with the appendix. Fluoroscopy is especially useful in cases with stenosis or fistula formation as well as in cases of infiltration and inflammatory spread from outside the lumen. We herein introduce the fluoroscopy procedures for barium enema and small bowel radiography performed at our department and reveal the results of advanced carcinoma of the ascending colon, lymphoma, carcinoid tumor, appendiceal goblet cell adenocarcinoma, Behçet disease, small bowel tuberculosis, and familial Mediterranean fever gene-related enteritis along with endoscopic results. Selecting radiographic methods and imaging techniques according to the site and nature of the lesion is important, and crucial information may be obtained not only through double contrast imaging but also through dynamic imaging, including filling and compression images.