腹腔鏡下に診断・治療をしえた回腸重複腸管の1例

A case of ileal duplication which was diagnosed and operated with laparoscopy

◆要旨：患者は22歳，男性．上部・下部消化管内視鏡，CTで原因不明の貧血に対し2014年1月にカプセル内視鏡（CE）を施行し，Crohn病（CD）が疑われたが，CEは滞留した．3月にダブルバルーン内視鏡で回腸に狭窄病変を認めたが，疼痛が強く拡張困難であったため，腹腔鏡補助下に手術を施行した．Bauhin弁から30cm口側に狭窄病変と，その15cm口側に内腔にCEが迷入した回腸重複腸管を認め，狭窄病変から重複腸管まで切除した．病理組織診断はCDであった．CEを施行する際は消化管の開通性の評価が重要であり，滞留の際は狭窄のみならず憩室や重複腸管も念頭に置く必要があると考えられた．また，その際に腹腔鏡下手術は低侵襲であり，診断かつ治療に有効な手段と考えられた．

　We herein report an extremely rare case of ileal duplication in which the endoscopic capsule was retained during endoscopy. A 22-year-old male visited a previous hospital with severe anemia in September 2013. Computed tomography, gastroscopic and colonoscopic examinations were performed, revealing no abnormal findings. His symptoms resolved with the administration of iron. In December 2013, he presented to our hospital with severe anemia associated with bloody stool and underwent a capsule endoscopy to investigate the possible existence of small bowel disease; however, the capsule became entrapped at a stenosis in the ileum. We made the diagnosis of the stenosis of the ileum by double-balloon enteroscopy. We subsequently performed a laparoscopy-assisted partial resection of the ileum in May 2014. A tubular communication duplication of the ileum containing the capsule was proximal to the stenosis in the ileal resection specimen. Crohn's disease was diagnosed based on the pathological examination of the stenotic lesion. It is considered important to perform a dummy capsule examination or radiological examinations prior to the actual capsule enteroscopy to eliminate the risk of capsule retention and keep the possibility of diverticulum or duplication of alimentary tract in mind when a capsule is entrapped. Furthermore, laparoscopic-assisted surgery is considered to be a useful method for those diagnosis and treatment.