イレウスを初発症状とした回腸子宮内膜症の診断にMRIが有用であった2例  [in Japanese] The Feasibility of MRI for Small Bowel Obstruction Because of Ileal Endometriosis. Two Case Reports  [in Japanese]

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Abstract

<p>イレウスを呈する消化管疾患は悪性腫瘍から良性疾患まで多岐にわたるため,治療方針の決定に術前診断が重要である.特に回腸子宮内膜症のような良性疾患でイレウスを初発症状とする場合,術前診断が困難である反面,手術の低侵襲化が求められる.通常,イレウス時の緊急画像診断としてCTや消化管造影が施行され,MRIが行われることは少ない.しかし,回腸を含む腸管子宮内膜症のMRIでは,脂肪抑制T1強調画像で点状の高信号域,T2強調画像で強い低信号という特徴を有す.このため,閉経前の女性のイレウスに遭遇した時,イレウス管挿入前のMRIにより回腸子宮内膜症の術前診断が可能となり,治療の低侵襲化も期待できる.</p><p>今回,われわれはイレウスを初発症状とした40歳代の女性2人に回腸子宮内膜症を疑い,MRIを施行した.MRIによる回腸子宮内膜症の術前診断の下,腹腔鏡手術によるイレウス解除術を選択し良好な経過を得たので報告する.</p>

<p>Since digestive tract disorder associated with intestinal obstruction includes various diseases such as malignant tumor and benign disease, preoperative diagnosis is important to decide the treatment strategy. In particular, when treating a benign disease such as endometriosis of ileum presenting primary symptoms of intestinal obstruction, performing minimally invasive surgery is encouraged despite the difficulty of preoperative diagnosis. When diagnostic imaging of intestinal obstruction is urgently needed, CT and gastrointestinal contrast examination are usually used but MRI is seldom performed. MRI of intestinal endometriosis characteristically shows a dotted high intensity area on fat suppressed T1-weighted image and a markedly low intensity area on T2-weighted image. When treating intestinal obstruction of premenopausal women, therefore, MRI prior to inserting an ileus tube enables preoperative diagnosis of endometriosis of the ileum, which is expected to realize minimally invasive treatment.</p><p>In this study, we report two cases of women in their 40ʼs who were suspected of endometriosis of ileum presenting primary symptoms of intestinal obstruction and underwent MRI; based on the preoperative definitive diagnosis of endometriosis of the ileum, we opted to perform laparoscopic reduction of intestinal obstruction and the patients had an uneventful postoperative course thereafter.</p>

Journal

  • Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)

    Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons) 43(1), 77-83, 2018

    Japanese College of Surgeons

Codes

  • NII Article ID (NAID)
    130007605315
  • Text Lang
    JPN
  • ISSN
    0385-7883
  • Data Source
    J-STAGE 
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