膵囊胞性腫瘤に対する腹腔鏡下脾温存膵体尾部切除後の病理検査にて後腹膜重複腸管と診断された1例

A case of retroperitoneal duplication cyst diagnosed by pathology after laparoscopic spleen preserving distal pancreatectomy for a cystic mass of the pancreas

◆要旨：症例は49歳，女性．CT検査で偶発的に膵体尾部の囊胞性病変を指摘された．充実性偽乳頭状腫瘍や後腹膜腫瘍の術前診断で，腹腔鏡下に観察した．病変は後腹膜に存在し，膵臓との剝離は困難であったため，脾温存膵体尾部切除を施行した．病理組織からは膵体尾部との交通はなく，後腹膜に発生した重複腸管の診断に至った．特に成人例で発見される重複腸管の症例は非常に稀である．偶然に発見される症例から腹痛などの有症状の場合もあるが，術前に確定診断に至らないことも多い．内腔の粘膜に悪性組織を認める症例もわずかに存在するため，治療は外科的切除が望ましい．

　The case is a 49-year-old woman. A cystic lesion in the pancreatic body tail was noted incidentally during a CT scan of another site. It was observed laparoscopically with a preoperative diagnosis of an solid pseudopapillary tumor or retroperitoneal tumor. Dissection of the pancreas from the pancreas was difficult, and a splenic-sparing distal pancreatectomy was performed. Histopathology revealed no invasion with the body tail, leading to the diagnosis of a primary duplicated intestinal tract of retroperitoneal origin.

　Adult cases of enteric duplication cyst are extremely rare. This type of cyst may be discovered by accident or through symptoms such as abdominal pain. In most cases, a definitive diagnosis is not reached before surgery. Most of the histopathological tissues are benign, but several cases show malignant tissues in the mucosa of the lumen. Thus, surgical resection is desirable for treatment.