貧血を契機に発見された空腸 pyogenic granuloma の1例 A CASE OF PYOGENIC GRANULOMA OF THE JEJUNUM FOUND IN A PATIENT WITH ANEMIA

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症例は79歳,女性.主訴は労作時動悸・胸痛.上下部消化管内視鏡検査,出血シンチ,CTにて異常を認めず,小腸内視鏡検査にて口角より約270cmの空腸に径約20mmの可動性のある易出血性の有茎性隆起病変を認めた.細胞診の結果は肉芽組織と炎症細胞を認めるのみであった.診断・治療のため小腸部分切除を施行.病理組織学的には表面にびらんがあり,浮腫状の間質中に大小の血管増生を認め,一部では分葉状に血管増生がみられpyogenic granuloma(化膿性肉芽腫)と診断した.本疾患の口腔粘膜以外の消化管発生の報告は極めて稀であり,消化管全体の本邦報告例は29例でそのうち空腸発症例は自験例を含め3例のみであった.大量下血例,再発例も報告されており,完全切除と経過観察が必要で,原因不明の消化管出血においては本疾患も念頭に置いておくべきと考える.

The patient was a 79-year-old female with complaints of exertional palpitation and chest pain. Upper gastrointestinal endoscopic study, blood pool scintigraphy and CT study did not reveal any abnormal findings. Endoscopic study of the small intestine revealed a mobile, easily bleeding pedunculated protruding tumor of about 20mm in size in the jejunum at about 270cm from the mouth. Cytology study of the tumor revealed granulating tissue and inflammatory cells. Segmental resection of the jejunum was performed for diagnosis and treatment. Pathohistological study revealed superficial erosions, proliferation of vessels of different sizes in the edematous interstitial space and partial leaflet like proliferations were observed. Accordingly the diagnosis of pyogenic granuloma was made. Pyogenic granuloma which arises in the intestinal tract other than in oral mucosa is extremely rare and only 29 cases are reported in Japan until now. The ones that arose in the jejunum are only 3 cases including ours. Massive melena and recurrences are reported and so a complete resection and careful follow-up are important. In case of intestinal bleeding of unknown origin, the possibility of this pathology should be included in the differential diagnosis.

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 69(7), 1697-1700, 2008-07-25 

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10021944686
  • 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  J-STAGE 
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