佐藤 敦彦¹, 東 俊宏³, 岩堂 昭太⁴, 藤田 政雄², 松浦 美穂子¹, 川田 幹浩¹, 小川 裕道¹

Atsuhiko SATO¹, Toshihiro HIGASHI³, Shota IWADO⁴, Masao FUJITA², Mihoko MATSUURA¹, Mikihiro KAWADA¹, Hiromichi OGAWA¹

¹香川県済生会病院内科, ²香川県済生会病院検査科, ³岡山市立市民病院内科, ⁴西条中央病院内科

¹Department of Internal Medicine, Kagawa-ken Saiseikai Hospital, ²Department of Clinical Laboratory Medicine, Kagawa-ken Saiseikai Hospital, ³Department of Internal Medicine, Okayama Citizens' Hospital, ⁴Department of Internal Medicine, Saijyo Chuo Hospital

キーワード : ileocecal valve syndrome, lipohyperplasia of the ileocecal valve, peridiverticular abscess, preoperative ultrasonography

我々は, 回盲部憩室穿孔症例の開腹手術前に体外式超音波検査を行い, 以下の如く極めて印象的な回盲弁lipohyperplasiaと穿孔部周囲膿瘍を同定し得た. すなわち, 回盲弁の粘膜下層は全周性に著明に肥厚し, 内部に斑状の低エコー域を伴った高エコー帯を呈した. 切除標本との比較の結果, この高エコー帯は回盲弁に不規則に沈着した脂肪組織に由来することを示唆している. 一方, 憩室穿孔部周囲膿瘍は上行結腸の腸間膜付着側に, 三角形の辺縁不整な低エコー領域として観察された. これまでに体外式超音波検査にて回盲弁lipohyperplasiaを同定し, その超音波所見と外科的切除標本との対比検討を行った報告はなく, 本邦第1例として呈示した.

We used preoperative ultrasonography to study a case of perforated diverticulosis of an ileocecal lesion, and identified lipohyperplasia of the ileocecal valve and a peridiverticular abscess characterized by its remarkable appearance in sonographic images. The circumference of the submucosal layer of the valve was markedly thickened and contained speckled hypoechoic areas within a highly hyperechoic zone. Comparison with the resected specimen suggested that the hyperechoic zone was derived from the irregularly deposited adipose tissues of the valve. On the other hand, the peridiverticular abscess contained a triangular hypoechoic area with an irregular margin at the site of mesenteric attachment of the ascending colon. We believe this to be the first case of lipohyperplasia of the ileocecal valve reported in Japan. We describe preoperative findings and compare them with those of the resected specimen.