下行結腸膜垂炎の1例 A Case of Epiploic Appendagitis of the Descending Colon

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著者

    • 泉 信一 IZUMI S.
    • 手稲渓仁会病院消化器病センター Center for Gastroenterology, Teine-Keijinnkai Hospital
    • 後藤 充 GOTOU M.
    • 手稲渓仁会病院消化器病センター Center for Gastroenterology, Teine-Keijinnkai Hospital
    • 野村 昌史 NOMURA M.
    • 手稲渓仁会病院消化器病センター Center for Gastroenterology, Teine-Keijinnkai Hospital

抄録

患者は52歳,男性.左下腹部痛を主訴に外来を受診し,触診で同部に圧痛を伴う鶏卵大の腫瘤を触知したため精査目的に入院となった.注腸X線検査では,SDjunction近傍の下行結腸外側に,長径約2cmにわたる片側性の壁不整像を認めた.病変の立ち上がりは比較的なだらかで,辺縁の一部は鋸歯状に突出していたが,上皮性病変を疑う所見はみられなかった.注腸X線からは,漿膜側からの圧排,浸潤所見と考えられた.大腸内視鏡検査では下状結腸になだらかに立ち上がった粘膜下腫瘍様の隆起を認めた.病変の表面は正常粘膜で覆われ,明らかなびらんや潰瘍形成はみられなかった.内視鏡所見からも壁外からの圧排,浸潤が疑われた.腹部CT検査では,同部位に一致して限局性の腸管壁肥厚所見およびsoft tissue density上昇を認めた.限局した脂肪組織の炎症を疑ったが,質的診断は困難であった.開腹術を施行したところ,下行結腸遠位側に腫大した暗赤色の腹膜垂を認め,腹膜垂のみを切除した.病理組織学的検索ではうっ血,壊死,炎症性細胞浸潤を認め,腹膜垂炎と最終診断した.腹膜垂炎の術前診断は困難であり,本例は特徴的な画像所見がとら得られた稀な症例と考え報告した.

A 52-year-old man was admitted to our hospital with progressive and constant pain in the left lower abdomen. An elastic, tender, egg-sized mass was present in the left lower abdomen. Barium enema radiography revealed an extrinsic compression and a mucosal crenulation in the distal side of the descending colon. Colonoscopic examination showed a submucosal tumor-like protruded lesion covered with normal mucosa in the descending colon, and neither erosion nor ulceration was seen.<BR>Computed tomography revealed wall thickening of the descending colon, with an increase of the surrounding fat tissue density. Although localized inflammation of adipose tissue was suspected, no definite diagnosis was possible.<BR>At laparotomy, an enlarged, dark-red epiploic appendage was found on the distal side of the descending colon, and resection of the inflamed epiploic appendage was performed.<BR>Pathological examination showed congestion, necrosis, and infiltration of inflammatory cells and foamy cells.<BR>The diagnosis of epiploic appendagitis was established. It is extremely difficult to make a definite diagnosis of epiploic appendagitis prior to surgery ; none of the case reports were diagnosed preoperatively. The present case is thought to be a rare case in which the morphologic characteristics of epiploic appendagitis were displayed.

収録刊行物

  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 55(5), 239-242, 2002-05-01

    The Japan Society of Coloproctology

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