腹腔鏡下に切除した虫垂神経線維腫の1例

A case of neurofibroma of the appendix resected by laparoscopic surgery

◆要旨：患者は40歳のvon Recklinghausen病（以下，R病）の既往を有する女性．右下腹痛を主訴に来院し，腹部CTと大腸内視鏡検査にて虫垂腫瘍に伴う腸重積を指摘された．内視鏡の送気により腸重積を解除した後，腹腔鏡下に切除術を施行した．臍部に12mm，両側側腹部に5mmのトロッカーを挿入し，手術を施行した．虫垂中部に長径1.5cm大の腫瘍が認められた．腹腔鏡下に断端を確保して自動縫合器で虫垂腫瘍を切除した．腫瘍は粘膜下を中心に発育した神経線維腫であった．術後経過は良好で10病日目に退院した．R病は種々の腫瘍性病変を合併することが知られているが，虫垂の神経線維腫は稀であり，自験例はわが国で第1例目であった．腫瘍の腹腔鏡下切除にあたっては，術前の重積解除は有用と考えられた．

　We experienced a rare case of neurofibroma of the appendix associated with intussusception.

　A 40-year-old female was admitted to Saiseikai Sendai Hospital with a complaint of right lower abdominal pain. She had a history of Von Recklinghausen's disease. Abdominal CT and colonoscopy revealed the tumor of the appendix and intussusception of the ileocecal region. Intussusception of the ileo-cecal region was released by air pressure from the colonoscope. After releasing the intussusception, elective laparoscopic appendectomy was performed for the tumor formation of the appendix. Entering the abdomen, the tumor was found at the middle part of the appendix. The tumor was resected keeping a surgical margin with suturing instrument. The tumor was derived from the submucosal layer of the appendix. Intraoperative pathological examination revealed neurofibroma of the appendix. The patient was discharged after 10 days' hospitalization without complication. Neurofibroma of the appendix is extremely rare, this was the second case report in Japan. Releasing intussusception using colonoscope is useful to perform elective and less invasive operation for the appendix tumor.