右下腹部痛(Right Lower Quadrant Pain)シリーズ16 EXPERT COURSE 解答 【症例 RE 80】

回腸憩室穿孔.Perforation of ileal diverticulum.






回腸末端(TI)は図2から始まるが,粘膜下浮腫により壁肥厚を呈している.図7〜図9の△は腸管外遊離ガスで,周辺の脂肪組織は高濃度を示している.図5と図6の↑は憩室と思われ,虚脱しているのは穿孔したからと解釈する.図8の1〜図13の8はやや腫大した虫垂であるが,炎症の中心は憩室周囲にあり,虫垂所見は二次的なものであろう.手術・病理所見:回腸憩室穿孔(図A:▲).









文献考察:小腸憩室.空腸に80%,合併症は6〜10%に起こす
Gastroenterologist. 1997 Mar;5(1):78-84.
Jejunoileal diverticula.
Chow DC, Babaian M, Taubin HL.
Jejunoileal diverticula are estimated to occur in 1-5% of the population. The incidence increases with age, peaking at the sixth and seventh decades. The pathogenesis is believed to involve an acquired defect of the intestinal smooth muscle or myenteric plexus. Eighty percent of jejunoileal diverticula are localized to the jejunum, 15% to the ileum, and 5% to both. Diverticula in the jejunum tend to be large and multiple, whereas those in the ileum are small and solitary. Symptoms of intermittent abdominal pain, flatulence, diarrhea, and constipation are reported in 10-30% of patients with jejunoileal diverticula. The radiographic diagnosis of these diverticula is difficult to establish. Enteroclysis should be reserved for patients who have persistent abdominal pain despite nonrevealing endoscopic and contrast enhanced studies of the upper and lower gastrointestinal tracts. Asymptomatic jejunoileal diverticula should be managed conservatively. Complications occur in 6-10% of patients and include obstruction, diverticulitis, hemorrhage, perforation, malabsorption, and chronic debilitating abdominal pain. When surgical therapy is indicated, intestinal resection with primary anastomosis is the preferred treatment.PMID: 9074921
  【参照症例】   1. 右下腹部痛シリーズ6 【症例 RE 27】

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