穿孔を来した成人回腸重複腸管症の1例 A Case of Ileal Duplication with Perforation in an Adult

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著者

    • 池田 義之 Ikeda Yoshiyuki
    • 新潟大学大学院消化器・一般外科学分野 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Science
    • 松木 淳 Matsuki Atsushi
    • 新潟大学大学院消化器・一般外科学分野 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Science
    • 石川 卓 Ishikawa Takashi
    • 新潟大学大学院消化器・一般外科学分野 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Science
    • 渡辺 玄 Watanabe Gen
    • 新潟大学大学院分子・診断病理学分野 Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Science
    • 畠山 勝義 Hatakeyama Katsuyoshi
    • 新潟大学大学院消化器・一般外科学分野 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Science

抄録

 症例は44歳の女性で,右下腹部痛と発熱を主訴に来院した.CTでは下腹部正中に液面形成を伴う35mm大の憩室状の構造物を認め,糞石を伴っていた.腹腔内遊離ガスと骨盤内の腹水を認め,血液検査上高度の炎症所見を伴い,小腸の憩室炎穿孔に伴う汎発性腹膜炎と診断し緊急開腹手術を施行した.Bauhin弁より50cmの回腸の腸間膜付着側に,10cmの管状,交通型の重複腸管があり,盲端が穿孔していた.重複腸管を含む回腸楔状切除術を行った.病理組織学的所見では回腸と連続した粘膜および筋層構造を認めた.盲端に高度の活動性炎症を認め,糞石の嵌頓による穿孔と考えられた.本邦における成人の回腸重複腸管の穿孔例を報告した文献は,自験例を加えて6例と極めてまれであるが,成人における急性腹症の鑑別疾患のひとつとして回腸重複腸管症を考慮する必要がある.

The patient was a 44-year-old woman. She was admitted to our hospital with a complaint of right lower abdominal pain and fever. Computed tomography showed a 35 mm diverticular structure in the lower abdominal region with air-fluid level, accompanied by a fecal stone. Free gas was seen in the abdominal cavity and ascites was confirmed in the pelvis. Blood tests demonstrated severe inflammation. The patient was given a diagnosis of diffuse peritonitis due to perforated diverticulitis of the small intestine, and underwent emergency operation. Ileal duplication was seen at the mesenteric side 50 cm oral from Bauhin's valve. It was 10 cm long and communicated with the ileum. The blind sac was perforated. Wedge resection of the ileum was performed, including the ileal duplication. Histopathological examination revealed the muscular layer and the mucosal lining that were continuous with the ileum. The blind sac developed severe active inflammation thought to be caused by perforation due to fecal stone impaction. In Japan, there are only six reported cases of ileal duplication due to perforation in adults, including our case. Ileal duplication due to perforation in adults is extremely rare but must be kept in mind as a differential diagnosis of the acute abdomen in adults.

収録刊行物

  • 日本消化器外科学会雑誌

    日本消化器外科学会雑誌 44(11), 1434-1440, 2011

    The Japanese Society of Gastroenterological Surgery

キーワード

各種コード

  • NII論文ID(NAID)
    130004907983
  • 本文言語コード
    UNK
  • ISSN
    0386-9768
  • データ提供元
    J-STAGE 
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