多量の腹腔内遊離ガス像を呈した腸管嚢胞様気腫の1例 A Case Report of Pneumatosis Cystoides Intestinalis Associated with a Large Amount of Free Air in the Abdominal Cavity

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腸管嚢胞様気腫はまれな疾患であるが,腹腔内遊離ガス像を呈し緊急手術の対象となることがある.われわれは上部消化管穿孔の診断にて開腹し,空腸の腸管嚢胞様気腫であった1例を経験したので報告する.症例は35歳,男性.主訴は腹部膨満.平成元年6月初めより腹部膨満が増強し,6月19日当科受診し,腹部膨満と腹部X線上腹腔内遊離ガス像を認め,消化管穿孔の診断で手術となった.手術時,腹腔内遊離ガスと腹水を認めたが,消化管穿孔部はなく,Treitz靭帯から約50cmの空腸に,10cmの長さにわたり腸管壁の浮腫と肥厚を,またその領域の腸間膜の漿膜下にも多数の小空胞を認めたため,腸管嚢胞様気腫の診断で空腸部分切除を施行した.摘出標本は,粘膜面に直径約5mmの赤い,軟らかい隆起を多数認め,病理組織学的には,空腸粘膜面は正常で,粘膜下に多核巨細胞などの肉芽組織に囲まれた大きさの異なる多数の嚢胞が認められ,原発性腸管嚢胞様気腫と考えた.

Pneumatosis cystoides intestinalis is uncommon, but sometimes presents as free air in the abdominal cavity and may require an emergency operation. We report a patient treated for pneumatosis cystoides intestinalis in the jejunum, in hom gastro-intestinal perforation was suspected before surgery. The patient as a 35-year-old man. His chief complaint was abdominal distension gradually increasing during about 20 days before admission. He consulted our department on June 19, 1989. Marked abdominal distension and free air in the abdominal cavity were revealed by X-ray. From these findings, gastro-intestinal perforation was suspected and an emergency laparotomy was performed. The operative findings ere as follows: 1) 1600 ml of light yellow, clear serous ascitic fluid; 2) absence of perforation; 3) edematous thickening of the jejunal wall over 10 cm in length at approximately 50 cm from Treitz's ligament; 4) a number of vacuoles of various sizes in the subserosal layer of the jejunum and its mesentery. A diagnosis of pneumatosis cystoides intestinalis was made and the jejunum including the lesion was resected. The specimen showed a number of soft polypoid lesions about 5 mm in diameter in the mucosa. Histopathological examination revealed a number of cysts in the submucosal layer and these cysts were surrounded by granulomatous changes including polynuclear giant cells in the stroma. Moreover the inner surface of these cysts was covered by a lining of flat cells, and this was considered a case of "primary pneumatosis".

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 23(7), 1932-1936, 1990-07-01

    一般社団法人日本消化器外科学会

被引用文献:  7件中 1-7件 を表示

各種コード

  • NII論文ID(NAID)
    110001310220
  • NII書誌ID(NCID)
    AN00192066
  • 本文言語コード
    JPN
  • 資料種別
    雑誌論文
  • ISSN
    03869768
  • データ提供元
    CJP引用  NII-ELS 
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