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
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.
日本消化器外科学会雑誌 44(11), 1434-1440, 2011
The Japanese Society of Gastroenterological Surgery