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文献考察：Meckel憩室穿孔
１）虫垂切除術後イレウスにて発症した腹腔内膿瘍を伴ったMeckel憩室穿孔の1例(原著論文/症例報告)
Author：長田俊一(横浜掖済会病院), 高橋徹也, 亀田久仁郎, 福島忠男, 高橋利通
Source：臨床外科(0386-9857)56巻6号 Page841-844(2001.06)
Abstract：23歳男.虫垂切除術後のイレウスを主訴に来院した.腹部正中と左側に小腸ガスと鏡面像形成を認め,イレウス管造影で大腸完全閉塞が疑われた.炎症反応も遷延していたため,開腹術を行ない,膿瘍形成の中心部に,既に穿孔しているMeckel憩室を認めた.本例ではMeckel憩室炎を発症し,虫垂炎術後に憩室が穿孔して,それを腸管が覆い,腹腔内膿瘍を形成したことからイレウスを発症したと考えられた.成人例で憩室炎による穿孔は本例を含め6例の報告があるが,腹腔内膿瘍が原因のイレウスは本例のみである．
２）World J Surg. 1995 Sep-Oct;19(5):734-6; discussion 737.
Meckel's diverticulum in Amsterdam: experience in 136 patients.
Bemelman WA, Hugenholtz E, Heij HA, Wiersma PH, Obertop H.
The object of this study was to establish the relation of symptomatic diverticula to the age and gender of the patients and to the presence of ectopic tissue. A total of 136 patients with surgically treated diverticula were collected from the medical charts of five Amsterdam hospitals; 51 had undergone resection because of diverticulum-related symptoms and 85 during laparotomy for other causes. Obstruction was the predominant symptom (39%) in the 51 symptomatic patients. Hemorrhage, perforation, diverticulitis, and intussusception were the other symptoms (12-14% each). Obstruction occurred mainly in patients under age 10 years and perforation in patients 10 to 30 years old. All symptoms, hemorrhage excepted, occurred two to four times more in men. Hemorrhage and perforation were associated with the presence of ectopic gastric tissue. We concluded that symptoms caused by Meckel's diverticula are mainly due to the presence of bands or ectopic gastric tissue. The symptoms manifest at an early age (77% in those under age 30) and predominantly in males. Diverticula found incidentally in patients younger than 30 years should be resected. In the older patients, resection is indicated if ectopic gastric tissue is suspected. Diverticular bands can simply be cut.PMID: 7571672
追記：全合併症の中で穿孔例は16％を占めた．
３）J Am Coll Surg. 2001 May;192(5):658-62.
Meckel's diverticulum.
Yahchouchy EK, Marano AF, Etienne JC, Fingerhut AL.PMID: 11333103
上記文献のまとめ：憩室穿孔の機序は，１．異所性胃粘膜からの胃酸とペプシンの分泌による潰瘍の穿孔，２．憩室炎が進行し穿孔，３．異物による穿孔，４．憩室内に発生した腫瘍の穿孔，５．軸捻転による穿孔，などがいわれる．
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