Departmental Bulletin Paper 下血をきたした虫垂粘液嚢胞腺腫の1例
A Case of Mucinous Cystadenoma of the Appendix Accompanied with Intestinal Bleeding

庭野, 稔之  ,  西村, 淳  ,  岩城, 孝和  ,  川原, 聖佳子  ,  新国, 恵也  ,  Niwano, Toshiyuki  ,  Nishimura, Atsushi  ,  Iwaki, Takawa  ,  Kawahara, Mikako  ,  Niikuni, Keiya

130 ( 3 )  , pp.203 - 207 , 2016-03 , 新潟医学会
下血をきたした虫垂粘液嚢胞腺腫の1例を経験したので報告する. 症例は84歳, 男性. 5年前に心窩部不快感の精査のCTで短径25mmの虫垂嚢胞性病変を指摘された. 高齢かつ心疾患に対し抗凝固療法中であったため, 経過観察されていた. 下血, 倦怠感を主訴に救急搬送され, 血液検査で貧血, PT延長, CTで虫垂嚢胞内への造影剤漏出, 下部消化管内視鏡検査で虫垂開口部からの出血を認めた. 内視鏡的止血術は困難で, 単孔式腹腔鏡下虫垂切除・盲腸部分切除術を施行した. 病理検査では虫垂嚢胞腺腫の診断であった. 粘液嚢胞腺腫は良性疾患であるが, 腹膜偽粘液腫をきたすリスクがあり, 粘液嚢胞腺癌との鑑別が困難なため, 外科的切除が望ましい. 本症例のように抗凝固療法中の場合には, 消化管出血の原因となりうることを念頭におくべきである. 「緒言」 虫垂粘液嚢腫の発生頻度は全虫垂切除例の0.08~4.1%と報告されており, 腸重積, 腸軸捻転, 虫垂炎の原因となる場合がある.
We report a case of mucinous cystadenoma of the appendix accompanied with intestinal bleeding. A 84-year-old man had epigastric distress 5 years ago. Then, a cystic lesion of the appendix, 25mm in diameter, was detected in the CT scan. Considering his age and anticoagulant medication for ischemic heart disease, surgery was not selected. Because of acute melena and general fatigue, he was transferred to our hospital by ambulance. Blood chemical values showed anemia and prolongation of PT. CT scan showed intracystic leakage of contrast agent. Colonoscopy showed oozing from appendiceal orifice, and endoscopic hemostasis was difficult. Therefore, single incision laparoscopic appendectomy and partial resection of cecum was performed. Histopathological examination confirmed mucinous cystadenoma of the appendix. Mucinous cystadenoma, which is a benign disease, has the possibility of developing pseudomyxoma peritonei. Moreover, discriminating carcinoma is difficult. For these reason, it should be resected surgically. In addition, if the patient is under anticoagulant medication, We should consider the risk of intestinal bleeding.

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