繰り返す血便を主訴に発見され腹腔鏡下回盲部切除術によって切除しえた回腸動静脈奇形の1例

Successful laparoscopic ileocecal resection for arteriovenous malformation of the ileum with repeated gastrointestinal bleeding : A case report

◆要旨：患者は67歳，女性．4年前に血便を認め，他院にて内視鏡検査を施行した．回腸末端に出血性粘膜下隆起を認め，内視鏡的止血術を施行された．今回，再度血便と貧血の進行を認め当院を受診した．造影CT検査にて回腸末端に強い濃染像を伴う腫瘤影を認め，経肛門的小腸内視鏡検査にて回腸末端に発赤調の粘膜下腫瘍を疑う病変を認めた．以上より出血源として回腸粘膜下腫瘍が最も疑われ，十分なインフォームド・コンセントのもと，腹腔鏡下回盲部切除術を施行した．術後経過は良好で第9病日に退院となった．病理組織学的に隆起部の粘膜下層に拡張した動脈様血管と蛇行した静脈様血管を認め，回腸動静脈奇形の診断となった．術後1年経過した現在消化管出血の所見を認めていない．

　Gastrointestinal bleeding that originates in the small intestine is often difficult to diagnose. A 67-year-old woman with a history of endoscopic hemostasis for hemorrhagic submucosal protrusion in the terminal ileum was admitted to our hospital because of repeated gastrointestinal bleeding and anemia. Upper and lower gastrointestinal endoscopy were normal, and enhanced computed tomography （CT） revealed a hypervascular mass in the terminal ileum in the arterial phase. Single-balloon endoscopy identified the source of bleeding to be reddening submucosal tumor in the terminal ileum, suggestive of a vascular lesion. Preoperative tattooing was performed near the mass. Laparoscopic ileocecal resection was successful in removing the ileal mass and the patient was discharged on postoperative day 9. Histological evaluation of the mass was arteriovenous malformation. There has been no recurrence of gastrointestinal bleeding, 12 months after surgery. Preoperative single-balloon endoscopy can be useful for the diagnosis and localization of arteriovenous malformation in the small intestine, and laparoscopic approach seems to be beneficial for selected benign small bowel diseases.