内容紹介
Summary
The patient was a 67-year-old female without a history of surgery. She presented with an abdominal pain and vomiting, and was rushed to our hospital. The abdominal pain was severe, but no peritoneal irritation sign was observed. Abdominal CT scan revealed a strangulating intestinal obstruction and accumulation of ascitic fluid. Emergency surgery was performed for diagnosis and treatment. The intraoperative finding showed serous ascitic fluid and strangulating intestinal obstruction caused by appendiceal tumor coiling around the terminal ileum, which had become ischemic with thinning of its wall. Ileocecal resection with removal of lymph nodes(D3)was performed. The postoperative course was uneventful, and the patient was discharged 13 days after the surgery. Pathological examination of the appendiceal tumor revealed a low-grade appendiceal mucinous neoplasm(LAMN)with no metastasis to the lymph nodes. We had a rare case of strangulating intestinal obstruction caused by coiling of LAMN to the terminal ileum.
要旨
症例は手術歴のない67歳,女性。腹痛,嘔吐を主訴に当院へ救急搬送された。来院時下腹部は膨隆し,強い自発痛を認め,圧痛・腹膜刺激兆候は認めなかった。造影CT検査で小腸は拡張し,造影不良域はないが腹水の貯留を認めた。絞扼性腸閉塞を疑い,緊急手術を施行した。腹水は漿液性で,回腸結腸移行部に発赤腫大した虫垂が巻きついて腸閉塞を生じていた。巻きついた虫垂を剝離すると,回腸は菲薄化して色調不良を認め血流障害を来していた。虫垂腫瘍が原因であったため,D3郭清を伴う回盲部切除術を施行した。術後は良好に経過し,術後13日目に軽快退院した。病理結果は低異型度虫垂粘液性腫瘍(low-grade appendiceal mucinous neoplasm: LAMN)(TNM分類 第8版: TisN0M0,Stage 0)であり,再発なく外来通院中である。LAMNが原因となり腸管虚血を伴う腸閉塞を来した症例はまれではあるが,開腹歴のない腸閉塞の原因として念頭に置く必要があると考えられ,若干の文献的考察を加えて報告する。
目次
The patient was a 67-year-old female without a history of surgery. She presented with an abdominal pain and vomiting, and was rushed to our hospital. The abdominal pain was severe, but no peritoneal irritation sign was observed. Abdominal CT scan revealed a strangulating intestinal obstruction and accumulation of ascitic fluid. Emergency surgery was performed for diagnosis and treatment. The intraoperative finding showed serous ascitic fluid and strangulating intestinal obstruction caused by appendiceal tumor coiling around the terminal ileum, which had become ischemic with thinning of its wall. Ileocecal resection with removal of lymph nodes(D3)was performed. The postoperative course was uneventful, and the patient was discharged 13 days after the surgery. Pathological examination of the appendiceal tumor revealed a low-grade appendiceal mucinous neoplasm(LAMN)with no metastasis to the lymph nodes. We had a rare case of strangulating intestinal obstruction caused by coiling of LAMN to the terminal ileum.
要旨
症例は手術歴のない67歳,女性。腹痛,嘔吐を主訴に当院へ救急搬送された。来院時下腹部は膨隆し,強い自発痛を認め,圧痛・腹膜刺激兆候は認めなかった。造影CT検査で小腸は拡張し,造影不良域はないが腹水の貯留を認めた。絞扼性腸閉塞を疑い,緊急手術を施行した。腹水は漿液性で,回腸結腸移行部に発赤腫大した虫垂が巻きついて腸閉塞を生じていた。巻きついた虫垂を剝離すると,回腸は菲薄化して色調不良を認め血流障害を来していた。虫垂腫瘍が原因であったため,D3郭清を伴う回盲部切除術を施行した。術後は良好に経過し,術後13日目に軽快退院した。病理結果は低異型度虫垂粘液性腫瘍(low-grade appendiceal mucinous neoplasm: LAMN)(TNM分類 第8版: TisN0M0,Stage 0)であり,再発なく外来通院中である。LAMNが原因となり腸管虚血を伴う腸閉塞を来した症例はまれではあるが,開腹歴のない腸閉塞の原因として念頭に置く必要があると考えられ,若干の文献的考察を加えて報告する。