内容紹介
Summary
A 78-year-old man was referred to our hospital with diarrhea, melena, and weight loss. During a digital rectal examination, a protuberant mass located 7-8 cm above the anal verge was palpable. Computed tomography(CT)scans of his chest, abdomen, and pelvis revealed an intestinal obstruction with a target sign in the lower rectum, indicating intussusception due to a sigmoid colon mass. A gastrografin enema examination revealed a typical filling defect with a crab claw sign in the rectum. However, the enema did not reduce the intussusception. The surgical findings showed that the sigmoid colon had slipped inside the rectum, consistent with the diagnostic imaging findings. A radical sigmoidectomy(D2)with diverting colostomy was performed to address the unprepared colon with accompanying edema. Pathology of the resected specimen revealed a type 2 tumor measuring 5 cm in size and comprising moderately differentiated adenocarcinoma(pT3pN0M0, pStageⅡ). The patient's postoperative course was uneventful, and his stoma was closed 2 months later. Intussusception occurs less frequently in adults than in children. In a case of bowel-within-bowel configuration, in which layers of the bowel are duplicated to form concentric rings, the target-like sign on CT images may be a useful diagnostic marker of colorectal intussusception.
要旨
症例は78歳,男性。下痢,下血,体重減少を主訴に当院を受診した。直腸指診で肛門縁から7～8 cmに可動性腫瘤を触知した。胸腹部CT検査では下部直腸にtarget signを認め,S状結腸癌を先進部とする腸重積症と診断した。注腸造影では上部直腸に典型的なカニ爪様陰影欠損を認めた。手術所見はCT検査所見に一致してS状結腸が直腸内に重積していた。用手整復が可能であったものの口側腸管の浮腫と多量の便塊のため,縫合不全のリスクを考慮して一期的吻合は行わず,D2郭清を伴うハルトマン手術を施行した。摘出標本には5 cm大の2型腫瘍を認めた(pT3pN0M0,pStageⅡ)。術後経過は良好で,2か月後にストーマ閉鎖術を施行した。成人腸重積症は小児に比べてまれな疾患である。腸重積症のCT診断には,重積による同心円状の層構造を表すtarget signが有用な所見と考えられる。
目次
A 78-year-old man was referred to our hospital with diarrhea, melena, and weight loss. During a digital rectal examination, a protuberant mass located 7-8 cm above the anal verge was palpable. Computed tomography(CT)scans of his chest, abdomen, and pelvis revealed an intestinal obstruction with a target sign in the lower rectum, indicating intussusception due to a sigmoid colon mass. A gastrografin enema examination revealed a typical filling defect with a crab claw sign in the rectum. However, the enema did not reduce the intussusception. The surgical findings showed that the sigmoid colon had slipped inside the rectum, consistent with the diagnostic imaging findings. A radical sigmoidectomy(D2)with diverting colostomy was performed to address the unprepared colon with accompanying edema. Pathology of the resected specimen revealed a type 2 tumor measuring 5 cm in size and comprising moderately differentiated adenocarcinoma(pT3pN0M0, pStageⅡ). The patient's postoperative course was uneventful, and his stoma was closed 2 months later. Intussusception occurs less frequently in adults than in children. In a case of bowel-within-bowel configuration, in which layers of the bowel are duplicated to form concentric rings, the target-like sign on CT images may be a useful diagnostic marker of colorectal intussusception.
要旨
症例は78歳,男性。下痢,下血,体重減少を主訴に当院を受診した。直腸指診で肛門縁から7～8 cmに可動性腫瘤を触知した。胸腹部CT検査では下部直腸にtarget signを認め,S状結腸癌を先進部とする腸重積症と診断した。注腸造影では上部直腸に典型的なカニ爪様陰影欠損を認めた。手術所見はCT検査所見に一致してS状結腸が直腸内に重積していた。用手整復が可能であったものの口側腸管の浮腫と多量の便塊のため,縫合不全のリスクを考慮して一期的吻合は行わず,D2郭清を伴うハルトマン手術を施行した。摘出標本には5 cm大の2型腫瘍を認めた(pT3pN0M0,pStageⅡ)。術後経過は良好で,2か月後にストーマ閉鎖術を施行した。成人腸重積症は小児に比べてまれな疾患である。腸重積症のCT診断には,重積による同心円状の層構造を表すtarget signが有用な所見と考えられる。