佐々木 綾香¹, 内田 浩也², 三木 万由子³, 井谷 智尚¹, 三村 純¹, 大石 悠香², 山野 愛美², 登尾 薫², 佐藤 信浩², 橋本 公夫⁴

Ayaka SASAKI¹, Hiroya UCHIDA², Mayuko MIKI³, Toshinao ITANI¹, Jun MIMURA¹, Yuka OISHI², Megumi YAMANO², Kaoru NOBORIO², Nobuhiro SATO², Kimio HASHIMOTO⁴

¹西神戸医療センター消化器内科, ²西神戸医療センター臨床検査技術部, ³西神戸医療センター外科・消化器外科, ⁴西神戸医療センター病理科

¹Department of Gastroenterology, Nishi-Kobe Medical Center, ²Department of Clinical Laboratory, Nishi-Kobe Medical Center, ³Department of Surgery, Nishi-Kobe Medical Center, ⁴Department of Pathology, Nishi-Kobe Medical Center

キーワード : small intestinal diverticulosis, intestinal perforation, terminal ileum, ultrasonography

腹部超音波検査で診断された小腸憩室炎の1例を報告する．症例は79歳男性で，右下腹部痛と発熱のため来院した．右下腹部に限局した腹膜刺激症状を認め，症状からは急性虫垂炎，大腸憩室炎が疑われたが，腹部超音波検査，CT検査にて虫垂の腫大や上行結腸の炎症性変化は認めず，終末回腸に強い壁の肥厚性変化と小腸憩室，膿瘍形成を認めた．小腸憩室炎の腸間膜内穿破による腸間膜膿瘍の術前診断で回盲部切除術を施行した．バウヒン弁から10 cmの終末回腸に憩室を認め穿通し腸間膜膿瘍を形成していた．病理組織学的所見と併せて，回腸憩室穿通による腸間膜膿瘍と診断した．腹部超音波検査は術前診断に非常に有用であった．

We report a case of small intestinal diverticulitis diagnosed with abdominal ultrasonography. A 79-year-old man presented with right lower quadrant abdominal pain and fever. Because the physical examination showed tenderness and muscular guarding, we suspected local peritonitis due to acute appendicitis or diverticulitis of the ascending colon. However, ultrasonography and CT scan showed severer inflammatory change not in the ileocecal region. There was also no sign of local peritonitis caused by perforation of acute appendicitis. There was a mass lesion in the terminal ileum, 10 cm proximal to the ileocecal valve, which was found to be a mesenteric abscess secondary to perforation of the terminal ileum. The pathological diagnosis of this case was mesenteric abscess caused by a penetrated diverticulum of the terminal ileum. Ultrasonography was very useful in the preoperative diagnosis.