腹腔鏡下に切除しえた空腸腸間膜仮性囊胞の1例

A case of jejunal mesenteric pseudocyst resected by laparoscopic surgery

腸間膜囊胞は比較的稀な疾患で，発生頻度が入院患者10万人に1人といわれている．なかでも仮性囊胞は極めて稀とされている．今回筆者らは，腹腔鏡下に切除しえた空腸腸間膜仮性囊胞の1例を経験したので報告する．症例は63歳の男性で，近医で血尿を主訴に腹部CT検査を施行された．直径5cmの腹腔内腫瘍を認め，精査および加療目的にて当科を紹介された．腹部超音波検査，腹部造影CT検査，multiplanar reformation，腹部MRI，血管造影検査，上部消化管造影では上部空腸腸間膜内の内部石灰化を有する乏血性の囊胞様病変と思われた．空腸腸間膜囊胞と診断し，診断確定，および治療目的にて腹腔鏡下囊胞摘出術を施行した．病理組織学的には囊胞壁の内面に上皮細胞を認めず，線維性組織によって形成されており，空腸腸間膜に発生した仮性囊胞と診断した．本疾患に対する腹腔鏡下手術は低侵襲性や整容上の利点だけでなく，診断的意義や腸間膜周囲の繊細な剝離操作の観点からも有用な治療法であると考えられた．

　Mesenteric cyst is a relatively rare disorder which occurs at the rate of one case in about 100 thousand admission patients. A pseudocyst is very rare among them. We report a case of a jejunal mesenteric pseudocyst that was successfully resected by laparoscopic surgery. A 63-year-old man went to another hospital for examination of macrohematouria. Computed tomography（CT）revealed a tumor 5 cm in length, in his abdominal cavity, and he was referred to our hospital for further examination. Abdominal ultrasonography, enhanced CT, multiplanar reformation, MRI, angiography and upper gastrointestinal series revealed a hypovascular tumor with calcification in the upper jejunal mesenterium. Laparoscopic cystectomy was performed to make a pathological diagnosis. Microscopically, the cyst wall consisted of fibrous tissue, and no endothelial lining was detected. These findings showed that the tumor was a mesenteric pseudocyst. Laparoscopic surgery for mesenteric pseudocyst provides not only less invasiveness and cosmetic advantage, but also precise diagnosis and fine dissection around the mesentery.