上田 信恵¹, 福原 崇之², 山中 秀彦³, 嶋谷 邦彦⁴, 立山 義朗^{1, 5}

Nobue UEDA¹, Takayuki FUKUHARA², Hidehiko YAMANAKA³, Kunihiko SHIMATANI⁴, Yoshiro TACHIYAMA^{1, 5}

¹独立行政法人国立病院機構広島西医療センター臨床検査科, ²独立行政法人国立病院機構広島西医療センター肝臓内科, ³独立行政法人国立病院機構広島西医療センター消化器内科, ⁴独立行政法人国立病院機構広島西医療センター外科, ⁵独立行政法人国立病院機構広島西医療センター病理診断科

¹Department of Clinical Laboratory, The National Hospital Organization Hiroshima-Nishi Medical Center, ²Department of Hepatology, The National Hospital Organization Hiroshima-Nishi Medical Center, ³Department of Gastroenterology, The National Hospital Organization Hiroshima-Nishi Medical Center, ⁴Department of Surgery, The National Hospital Organization Hiroshima-Nishi Medical Center, ⁵Department of Diagnostic Pathology, The National Hospital Organization Hiroshima-Nishi Medical Center

キーワード : appendiceal diverticulitis, ultrasonography, preoperative diagnosis

症例は63歳男性，3日前から続く右下腹部痛のため当院を受診した．触診にて右下腹部に圧痛と反跳痛を認め，血液検査では，白血球8,800/μl，CRP 14.89 mg/dlと炎症反応の上昇を認めた．腹部造影CTでは，虫垂の腫大および周囲の脂肪織濃度の上昇を認め急性虫垂炎と診断したが，腹部超音波検査では，虫垂は腫大し層構造は保たれ，虫垂中央から末端にかけて突出する低エコー腫瘤と，腫瘤周囲に局在した脂肪織の著明な肥厚を認めるなどの所見から虫垂憩室炎と診断し得た．摘出標本の病理組織学的診断は真性虫垂憩室炎であった．超音波検査は虫垂憩室炎の術前診断に非常に有用であった．

A 63-year-old man presented to our hospital with a 3-day history of lower right abdominal pain. Examination revealed tenderness and rebound tenderness in the lower right quadrant. Laboratory tests showed a white blood cell count of 8,800/μl, and C-reactive protein level of 14.89 mg/dl. Abdominal contrast-enhanced computed tomography confirmed enlargement of the appendix with increased surrounding fat density of the appendix, suggesting acute appendicitis. Abdominal ultrasonography confirmed enlargement and the normal laminar wall structure of the appendix. There was a projecting hypoechoic mass at the distal portion from the center of the appendix, and significant thickening located in the fat tissue around the hypoechoic mass. Our final diagnosis was appendiceal diverticulitis. The histopathological diagnosis was true appendiceal diverticulitis. Abdominal ultrasonography was very useful for preoperative diagnosis in this case of appendiceal diverticulitis.