小腸迷入膵が原因と考えられた老年者消化管出血の1例 An Elderly Patient with Bleeding from the Alimentary Tract Caused by Aberrant Pancreas of the Small Intestine

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老年者の消化管出血は日常診療でしばしば遭遇する. しかし, 老年者では無症状のことが少なくなく, 見逃される可能性があり注意が必要である. 我々は71歳女性で消化管出血による高度の貧血をきたした症例を経験した. 患者の出血源は上部消化管造影, 小腸造影, 注腸造影および内視鏡検査では発見できず, 腹部血管造影で初めて出血源と思われる小腸腫瘍を同定し得た. 小腸切除術の結果, 腫瘍は径4×3×3.5cm大の管外性に発育した迷入膵と診断した. 消化管出血の原因として小腸からの出血が疑われる場合, 小腸造影では診断因難な壁外発育性の腫瘍や血管性病変を考慮し, 一度は腹部血管造影を試みるべきであると思われた. 小腸腫瘍からの出血は消化管出血のなかでも比較的まれであり, 特に本症例のように出血源と考えられ外科的切除にいたった小腸腫瘍が病理組織学的に迷入膵と診断されることは非常にまれである.

A 71-year-old woman was admitted to hospital because of malaise and bloody stool. Laboratory findings consistently showed anemia (Hb 9.2g/dl) and occult blood in the stool. Although barium series and endoscopy of the upper and lower intestinal tructs were carried out, there was no evidence of bleeding from the gastrointestinal tract. <sup>99m</sup>TcO<sup>-</sup><sub>4</sub> scintigraphy, which was performed to exclude bleeding from Meckel's diverticulum, also did not locate a significant lesion. Angiographic imaging of the superior mesenteric arteries (SMA) was performed to exclude lesions such as small intestine tumors with extraluminal growth and vascular abnormalities such as A-V malformation and it revealed the round encasement of arteries in the peripheral SMA region, strongly suggestive of a small intestine tumor. Surgery was performed and an extraluminally protruding tumor was found in the small intestine. The excised tumor was 4×3×3.5cm in size, are was diagnosed histologically as aberrant pancreas. The postoperative laboratory findings showed that the anemia had improved and occult blood was not detected in the stools. Although aberrant pancreas of the small intestine is a common benign tumor, it is a very unusual cause of bleeding from the alimentary tract.

収録刊行物

  • 日本老年医学会雑誌

    日本老年医学会雑誌 35(1), 53-56, 1998-01-25

    The Japan Geriatrics Society

参考文献:  13件中 1-13件 を表示

被引用文献:  3件中 1-3件 を表示

各種コード

  • NII論文ID(NAID)
    10008481168
  • NII書誌ID(NCID)
    AN00199010
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03009173
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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