腹腔鏡下に切除したTreitz靱帯近傍の腸間膜囊胞の1例

A case of mesenteric pseudocyst resected by laparoscopic surgery

◆要旨：患者は65歳，男性．人間ドックで腹腔内腫瘤を指摘され，増大傾向を認めたため当院に紹介された．CTでTreitz靱帯近傍に約40mm大の囊胞性腫瘤を認めた．腸間膜囊胞を第1に疑い，診断・治療目的に腹腔鏡下腫瘤摘出術を施行した．腫瘤はTreitz靱帯近傍の小腸間膜に認め，小腸と近接していたが連続性はなく腸間膜から発生したものと考えられた．病理診断は仮性腸間膜囊胞であった．医学中央雑誌で「腸間膜囊胞」「内視鏡手術」で検索すると，報告症例は10例であった（会議録除く）．腸間膜囊胞は悪性の可能性はきわめて少ないが診断は困難であることが多く，腹腔鏡による診断的切除の良い適応と考えられた．

The case pertains to a 65-year-old man in whom an abdominal mass was identified by a medical examination and was referred to our hospital due to a tendency for the mass to increase in size. A cystic tumor measuring approximately 40 mm was observed in the vicinity of the Treitz ligament upon CT. A mesenteric cyst was initially suspected and laparoscopic tumor resection was carried out for both diagnostic and treatment purposes. The tumor was observed in the mesentery in the vicinity of the Treitz ligament with no continuity, although it was in contact with the small intestine, leading to the belief that it was generated from the mesentery. The pathological diagnosis was a mesenteric pseudocyst. When a search was made for “mesenteric cyst” and “laparoscopic surgery” using the Japan Medical Abstracts Society Web system, 10 cases were thus identified（except for proceedings）. Mesenteric pseudocysts are very rarely malignant; however, an accurate diagnosis is difficult to make in many cases, and therefore laparoscopic resection for diagnostic purposes is believed to be suitable.