巨大横隔膜上食道憩室の1例 A CASE OF A HUGE EPIPHRENIC ESOPHAGEAL DIVERTICULUM

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食道憩室の多くは無症状であり,外科的治療の適応となることが少ない.検診にて発見され,経過中に増大傾向を示した巨大横隔膜上憩室に対し手術を施行した1例を経験したので文献的考察を加えて報告する.症例は45歳,女性.検診の上部消化管造影にて横隔膜上憩室を指摘されたが自覚症状を認めないため経過観察されていた.以後,憩室の増大傾向を認めたために当院受診となった.食道造影で胸部下部食道左側壁に7.5cm大の嚢状憩室を認め造影剤の排出は不良であった.上部消化管内視鏡検査では下部食道左壁に憩室開口部を認め,憩室の内腔に食物残渣が貯留していた.以上より横隔膜上憩室と診断した.増大傾向と憩室内容の排出不良を認める圧出性憩室であるため手術を施行した.圧出性憩室の発生機序を考慮し経腹的に憩室切除術,食道胃接合部中心に5cmの粘膜外筋層切除術,胃底部縫着術を施行し良好な経過を得た.

Esophageal diverticulum is usually asymptomatic and few cases are indicated surgical therapy. This paper presents a surgical case of a huge epiphrenic diverticulum which was detected at a medical checkup and showed an increasing tendency during clinical course, together with some bibliographical comments.<br>A 45-year-old woman, who had been followed for asymptomatic epiphrenic diverticulum detected on an upper gastrointestinal series at a medical checkup, was admitted to the hospital because of an increasing tendency of the diverticulum. Esophagography revealed a 7.5-cm cystic diverticulum on the left wall of the thoracic lower esophagus, when the exudation of contrast material was poor. Upper gastrointestinal endoscopy showed an opening of the diverticulum on the left wall of the lower esophagus, and retention of saburra in the lumen of the diverticulum. Epiphrenic diverticulum was resultantly diagnosed. Because the patient's diverticulum was of pulsion diverticulum with the increasing tendency and poor exudation of its contents, an operation was indicated. Considering the etiolosic mechanisums of pulsion diverticulum, we performed a transabdominal removal of the diverticulum, an extra mucosal excision of tunica muscularis with the diameter of 5cm around the esophagogastric junction, and sutures of the gastric fundus, resulting in uneventful postoperative course.

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 65(3), 651-655, 2004-03-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10012865092
  • 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  CJP引用  J-STAGE 
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