小腸軸捻転を伴った骨盤内小腸GISTの1切除例 [in Japanese] A CASE OF INTRAPELVIC GASTROINTESTINAL STROMAL TUMOR OF THE SMALL INTESTINE WITH SMALL INTESTINAL VOLVULUS [in Japanese]
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症例は79歳の女性で, 2005年3月下旬に右下腹部痛で入院した.造影CT検査にて小腸軸捻転を疑う所見と骨盤内に径10cmを超える腫瘍性病変がみられた.この腫瘍は卵巣腫瘍などとの鑑別を要したが上腸間膜動脈 (SMA) からの造影効果を認め,約1カ月間の経過で増大傾向がみられたことから小腸由来の悪性腫瘍の診断で手術となった. SMAを軸に時計回りに540度の小腸捻転を認めた.捻転小腸に癒着や血流障害はなく容易に整復できた.腫瘍は,回腸末端部より約lOOcm口側の腸間膜付着部反対側の腸管壁に由来するものであった.小腸部分切除とともに腫瘍を摘出した.術後病理検査にて小腸GISTと診断された.腫瘍径は14×10cmと大きく,高リスク群に分類されたが,明らかな転移性病変はなく,肉眼的に根治性が得られたため,術後補助化学療法は行っていない.検索した限りでは,絞扼を認めない小腸軸捻転を伴った骨盤内小腸GISTの報告は本症例が初めてである.
We report a case of intrapelvic gastrointestinal stromal tumor (GIST) of the small intestine with a 540° small intestinal volvulus. To our knowledge, this is the first reported case in the literature of intrapelvic GIST of the small intestine with volvulus.<br> A 79-year-old woman complaining of right lower abdominal pain was admitted to Hokkaido Prefecture Esashi Hospital. She was found to have an intrapelvic tumor about 10cm in diameter and a spiral intestine by abdominal enhanced computed tomography (CT). The intrapelvic tumor was first suspected to be a gynecologic tumor, and she was diagnosed as volvulus of the small intestine and the greater omentum. However, the intrapelvic tumor had been enhanced by superior mesenteric artery (SMA) angiography and was then diagnosed as an intestinal tumor.<br> At laparotomy, we found the 540° small intestinal volvulus. The intestine did not show necrotic changes and adhesions, and was easily moved to the normal position. The intrapelvic tumor measured was 14-10cm, and was located in the ileum 100cm from the end of Bauhin's valve. Partial resection of the small intestine involving the tumor was carried out. Postoperative pathological diagnosis was GIST of the small intestine. The immunohistochemical stainings of c-kit and CD34 were positive. Because she had no metastasis and had to undergo a radical operation, adjuvant chemotherapy such as STI571 was not performed. Fluorodeoxyglucose positron emission tomography (FDG-PET) revealed no recurrence and no metastasis 4 months after the operation.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 67(11), 2635-2639, 2006-11-25
Japan Surgical Association