内容紹介
Summary
Background: Laparoscopic surgery in patients with retroperitoneal fibrosis has been reported to be difficult due to mesenteric and retroperitoneal fibrotic thickening. Here, we report a case of laparoscopic surgery with IgG4-related disease. Case presentation: A 60-year-old man with IgG4-related kidney disease and autoimmune pancreatitis was diagnosed with cecal cancer. Laparoscopic ileocecal resection was performed. Preoperative CT showed no evidence of retroperitoneal fibrosis but showed a localized fibro-inflammatory lesion between the retroperitoneum and mesentery in front of the right kidney due to interstitial nephritis. Intraoperative findings revealed focal adhesions in the duodenal front within the range consistent with CT findings. Conclusions: This report shows that the degree and extent of fibrosis were similar between preoperative CT and actual surgical findings. Thus, it is possible that tissue fibrosis in patients with IgG4-related disease could be predicted by preoperative CT.
要旨
症例は60歳,男性。IgG4関連腎臓病と自己免疫性膵炎に対して,ステロイド内服加療中であった。盲腸癌の診断で,腹腔鏡下回盲部切除術を施行した。術前CTでは後腹膜線維症の所見は認めなかったが,間質性腎炎のため右腎前面で後腹膜-結腸間膜間に限局的な脂肪織濃度上昇を認めた。術中所見はCT所見に一致した範囲で,十二指腸前面の限局的な癒着を認めた。本症例において,術前CTと実際の手術で線維化の程度や範囲が一致していたことから,IgG4関連疾患患者の手術における組織の線維化は術前CTで予測できる可能性が示唆された。
目次
Background: Laparoscopic surgery in patients with retroperitoneal fibrosis has been reported to be difficult due to mesenteric and retroperitoneal fibrotic thickening. Here, we report a case of laparoscopic surgery with IgG4-related disease. Case presentation: A 60-year-old man with IgG4-related kidney disease and autoimmune pancreatitis was diagnosed with cecal cancer. Laparoscopic ileocecal resection was performed. Preoperative CT showed no evidence of retroperitoneal fibrosis but showed a localized fibro-inflammatory lesion between the retroperitoneum and mesentery in front of the right kidney due to interstitial nephritis. Intraoperative findings revealed focal adhesions in the duodenal front within the range consistent with CT findings. Conclusions: This report shows that the degree and extent of fibrosis were similar between preoperative CT and actual surgical findings. Thus, it is possible that tissue fibrosis in patients with IgG4-related disease could be predicted by preoperative CT.
要旨
症例は60歳,男性。IgG4関連腎臓病と自己免疫性膵炎に対して,ステロイド内服加療中であった。盲腸癌の診断で,腹腔鏡下回盲部切除術を施行した。術前CTでは後腹膜線維症の所見は認めなかったが,間質性腎炎のため右腎前面で後腹膜-結腸間膜間に限局的な脂肪織濃度上昇を認めた。術中所見はCT所見に一致した範囲で,十二指腸前面の限局的な癒着を認めた。本症例において,術前CTと実際の手術で線維化の程度や範囲が一致していたことから,IgG4関連疾患患者の手術における組織の線維化は術前CTで予測できる可能性が示唆された。