下血を契機に発見された回腸重複腸管の一例 : 本邦報告例の検討を含めて  [in Japanese] A Case of Ileal Duplication Presenting with Bloody Stools  [in Japanese]

Access this Article

Search this Article

Author(s)

Abstract

症例は50歳男性.下血・腹痛を主訴に当院消化器科を受診,上部・下部消化管内視鏡検査,注腸造影検査で明らかな出血性病変は認めず,小腸造影で回腸に突出する腸管が描出され,重複腸管が疑われた.重複腸管からの出血と診断し,手術を施行した.術中所見では,回盲部より約45cm口側の回腸に7×65cmの球状型の重複腸管を認め,頚部で切除した.切除標本では頚部に潰瘍を認め,出血源と思われたが,組織学的に異所性胃粘膜は認めなかった.<BR>重複腸管は本邦では約400例(1949~2000)の報告例があるが,約65%が幼児期に発症しており,成人では少ない.出血例の多くは異所性胃粘膜を有しており,本症例のように異所性胃粘膜の存在しない重複腸管からの出血の報告例は極めて稀であり,若干の文献的考察を加えて報告した.

We report a rare case of Real duplication presenting with bloody stools. A 50-year-old man was admitted to our hospital with bloody stool and abdominal pain in November 1999. Gastroscopic and colonoscopic examinations showed no abnormal findings. Abdominal CT and small intestine radiography revealed cystic lesion on the distal ileum. Under a suspicion of deal duplication, at surgery cystic duplication (7.0×6.5cm) was found on the ileum, which was located 45cm cephalad to the ileo-cecal valve. The duplication was resected with an auto-suture instrument. Histological examination revealed that the duplication possessed a common proper muscle layer with the ileum ; it was covered by Real mucosa without ectopic mucosa, and a linear open ulcer was found near the neck. About 400 cases of duplication have been reported in Japan. Sixty-five percent of the cases are seen in infants, and adult cases are relatively rare. Proper preoperative diagnosis is often very difficult, and only 10 %of the cases are accurately diagnosed preoperatively. Bloody stools are a rare symptom of duplication, and almost all cases of bloody stools are associated with ectopic mucosa inside duplication.

Journal

  • Nippon Daicho Komonbyo Gakkai Zasshi

    Nippon Daicho Komonbyo Gakkai Zasshi 55(1), 43-46, 2002-01

    The Japan Society of Coloproctology

References:  6

Cited by:  9

Codes

Page Top