Mucosal tagにより腸閉塞をきたしたS状結腸憩室炎の1例 A CASE REPORT OF DIVERTICULITIS OF THE SIGMOID COLON WITH OBSTRUCTION BY A MUCOSAL TAG

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症例は58歳,男性.下腹部痛を主訴に来院した.腹部単純X線にて,鏡面形成を伴う拡張した大腸ガス像を認めた.腹部CT検査でS状結腸に腫瘤を認め,注腸検査ではS状結腸より口側は描出されなかった. S状結腸癌による腸閉塞を疑い,腸管の減圧を試みたが成功せず,同日緊急手術を施行した. S状結腸に周囲組織と固着する腫瘤を認め, S状結腸癌と診断し, S状結腸切除術を行った.摘出標本では,腸管壁の肥厚による狭窄部に,細長く伸びた有茎性ポリープが嵌入し内腔を閉塞していたが,腫瘍性病変は認めなかった.病理組織にて,分類不能大腸ポリープのmucosal tagにより腸閉塞を生じた, S状結腸憩室炎と診断した.閉塞をきたす大腸疾患の場合,憩室の存在が確認出来れば, mucosal tagなどの分類不能大腸ポリープの存在も念頭に置いて鑑別診断する必要があると考えられた.

A 58-year-old man reporting lower abdominal pain was found by abdominal plain x-ray to have dilated colonic gas with air-fluid formation. Abdominal computed tomography (CT) showed a tumor of the sigmoid colon. Barium enema studies did not visualize the oral side from the sigmoid colon and intestinal obstruction due to sigmoid colon cancer was suspected. Attempts to decompress the intestine were unsuccessful and emergency surgery was conducted that day a tumor was found adhering to the surrounding sigmoid colon tissues. Sigmoidectomy was done based on a diagnosis of sigmoid colon cancer. The surgical specimen showed a long pedunculated polyp incarcerated in a narrow segment of the sigmoid colon, whose wall was thickened and completely obstructed. No tumorous lesion was found. Histopathological findings showed diverticulitis of the sigmoid colon and a mucosal tag. Intestinal obstruction was thus caused by the mucosal tag. In colorectal disease with obstruction in which the presence of the diverticulum can be confirmed, we must differentially diagnose the possible presence of an unclassifiable colonic polyp such as a mucosal tag.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 62(5), 1232-1235, 2001-05-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10008390248
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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