術前敗血症をきたした，中心壊死を伴う小腸GISTの1例

A case of gastrointestinal stromal tumor of the ileum with septic shock due to central necrosis of the tumor

◆要旨：患者は68歳，女性．ふらつき・息切れを主訴に来院し，敗血症性ショックの診断で緊急入院となった．造影CTにて右下腹部に8cm大の腫瘤像を認め，ガリウムシンチにて同部位の炎症ないしは腫瘍の存在が示唆された．小腸造影では病変はバリウム貯留像として描出され，メッケル憩室炎を疑った．保存的に感染を治療した後，第29病日目に腹腔鏡下手術を施行した．回腸末端から150cmに位置する，腸間膜反対側に突出する病変を楔状切除した．組織学的に小腸gastrointestinal stromal tumor（GIST）と診断され，メッケル憩室と思われる所見は認められなかった．術後第11病日目に退院した．本症例は小腸GISTの壊死部分が小腸と連続したため，感染を合併したと考えられた．

　We report a case of gastrointestinal stromal tumor（GIST）of the small intestine suspected of Meckel's diverticulitis with septic shock. A 68-year-old woman was admitted to our hospital because of dizzness and dyspnea. Abdominal enhanced CT scan detected a low density area about 8 cm in diameter at the right lower abdomen. Gallium Gallium scintigram revealed accumulation in the same area. Barium radiography of the intestine showed retention of barium in the lesion. Laparoscopic operation was performed 29 days after admission under the diagnosis of Meckel's diverticulitits. Wedge resection of the intestine including the mass lesion about 150 cm oral to the terminal ileum was made. Immunohistochemical examination showed GIST, and there were no pathological findings suggesting Meckel's diverticulum. The postoperative course was uneventful, and she discharged from the hospital on the eleventh day after the operation. It was thought that the case developed sepsis because central necrosis occurred in the GIST of the small intestine.