回腸過誤腫性ポリープ(Peutz-Jeghers型ポリープ)を先進部とする成人腸重積症の1例  [in Japanese] INTUSSUSCEPTION IN AN ADUL TCAUSED BY HAMARTOMATOUS POLYP (PEUTZ-JEGHERS TYPE POLYP) OF THE ILEUM-A CASE REPORT-  [in Japanese]

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Abstract

患者は51歳,男性で腹痛,嘔吐を主訴に入院した.右側腹部に圧痛を伴う腫瘤を触知し,腹部超音波所見, CT所見より腸重積症と診断し,緊急手術を施行した.開腹所見では上行結腸内に回腸が重積しており,用手的に重積を整復した.重積腸管の血行障害,壊死は認めなかった.整復後の回腸の触診で回腸末端より70cm口側に腫瘤を触知したため,腫瘤を含め回腸を2cm切除した.摘出標本の肉眼所見では,腫瘤は表面粗造な山田IV型のポリープで病理組織学的にPeutz-Jeghers型ポリープと診断された.本患者は,口唇,口腔粘膜,四肢末端部の色素斑を欠き,遺伝性も認められなかったことより,不完全型Peutz-Jeghers症候群と思われた.小腸過誤腫の過去10年間の本邦報告例は16例であり,そのうちPeutz-Jeghers型ポリープは8例でそのほとんどが腸重積で発症している.成人の腸重積症では本疾患も念頭に置くべきであると思われた.

A 51-year-old man was admitted to the hospital because of abdominal pain and vomiting. A tumor with tenderness was palpable in the right loin. With an abdominal ultrasonography and CT scan, intussusception was diagnosed and an emergency operation was performed. Upon laparotomy, the ileum prolapsed into the ascending colon, and the intussusception was reduced by hands. No ischemic change nor necrosis was observed in the intussuscepted intestine. On palpation of the ileum after intussusception was reduced, a tumor 70cm distal from the terminal ileum was palpated, and the tumor with the ileum about 2cm in length was resected. On gross findings of the resected material, the tumor was diagnosed as Yamada's type IV polyp with a rough surface, and was histologically diagnosed as Peutz-Jeghers type polyp. Since the patient lacked in pigmented macule in the lips, oral mucosa, and peripheries of the extremities and had no hereditary factor, the patient might have incomplete type Peutz-Jeghers syndrome. Hamartoma of the small intestine is rare. As far as we know, 16 cases including present one have been reported in Japan in past ten years. In these cases, 8 cases are Peutz-Jeghers type polyp and almost of them are occurred as intussusception.<br> In coclusion, it is important to cosider Peutz-Jeghers type polyp as a probable underlying disease in case of adult intussusception.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 63(5), 1230-1234, 2002-05-25

    Japan Surgical Association

References:  15

Cited by:  8

Codes

  • NII Article ID (NAID)
    10008913206
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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