腸閉塞で発症したリンパ節病変を伴う回腸子宮内膜症の1例  [in Japanese] A Case of Ileal Endometriosis with Lymph-node Involvement Presented with Small Bowel Obstruction  [in Japanese]

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Abstract

症例は,43歳の女性.入院5カ月前に前医で腹式卵巣嚢胞核出術と子宮筋腫核出術を受け,経過良好で退院した.1カ月前の受診で持続する腹痛と腸管拡張を認め腸閉塞と診断.保存的加療後,症状改善なく当院紹介受診となった.腹部CT所見で腸閉塞を疑い,開腹手術を施行した.手術所見では,明らかな絞扼部位を認めず,回腸末端に1.5cm大の弾性硬の腫瘤を触知し,その口側腸管の拡張を認めた.悪性腫瘍が否定できなかったため,回盲部切除D3郭清を施行した.病理組織所見は,回腸末端部に輪状の狭窄を認めた.粘膜に病変認めず,狭窄部割面は白色,筋層から漿膜下組織の線維化が著明で内部に子宮内膜間質を伴った子宮内膜を認めた.腸管傍リンパ節にも子宮内膜組織の像を認めた.

The patient was a 43-year-old female undergone the resection of an ovarian cyst and enucleatic myomectomy by her previous doctor five months prior to her admission to our hospital. One month before her visit, she was diagnosed as having intestinal obstruction because she had persisting abdominal pain and intestinal dilatation. Conservative treatment was unsccussful and then she was referred to us. We suspected intestinal obstruction through an abdominal CT scan and performed laparotomy. The operative findings showed no apparent strangulated part but a solid and elastic mass with the size of 1.5cm at the terminal ileum, as well as dilatation of the intestine proximal to the tumor. We performed ileocecal resection and lymph node dissection because a possibility of malignancy could not be ruled out. The final histopathologic diagnosis was ileal endometriosis with lymph-node involvement. No lesion on the serosal layer was found, while the structural section was white, and fibrosis from muscularis to subserosa was prominent while endometrium involving stroma inside was recognized. The image of endometrial tissue was recognized in the intestinal lymph node as well.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 75(12), 3358-3363, 2014

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130005085352
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • Data Source
    J-STAGE 
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