■症例報告
思春期腸重積症を発症し緊急手術後に判明した回盲部悪性リンパ腫の1例
福永 遼平1, 植田 高弘1, 板橋 寿和1, 石木 義人2, 右田 真1, 伊藤 保彦1
1日本医科大学付属病院小児科
2日本医科大学付属病院救命救急科
A Case of Ileocecal Malignant Lymphoma with Pubertal Intussusception Revealed after Emergency Surgery
Ryohei Fukunaga1, Takahiro Ueda1, Toshikazu Itabashi1, Yoshito Ishiki2, Makoto Migita1 and Yasuhiko Itoh1
1)Departments of Pediatrics, Nippon Medical School
2)Emergency and Critical Care Medicine, Nippon Medical School
The majority of childhood intussusceptions have idiopathic causes, but 2.7% are due to an underlying disease, of which 5.5% can be attributed to malignant lymphoma. Age is an important factor in the onset of pathologically-related intussusceptions. We report a case in a 15-year-old boy who visited a prior hospital with a chief complaint of sudden-onset severe abdominal pain. Computed tomography revealed intussusception, and the patient was transferred to our hospital within several hours, where high-pressure enema reduction was performed. The ileocecum blockage could not be removed even after multiple high-pressure enemas, so emergency surgery was planned. Intraoperatively, dilation was observed at the terminal ileum, and a hard-mass tumor was palpated in the ileocecum. The ileocecal region containing the mass was excised. A diagnosis of diffuse large B-cell lymphoma was made on the basis of pathological examination, and chemotherapy was initiated. The patient has remained in remission for 2 years and is in good condition. The probability of an underlying diseases increases with age. Adolescent intussusception is often discovered due to the onset of acute abdomen and requires emergency surgery even in the absence of a prior diagnosis. The development of intussusception might be the first sign of malignant disease. In older children who have underlying diseases, as in this case, it is difficult to perform high-pressure enema reductions, even shortly after onset. In cases of intussusception in older pediatric patients, it is necessary to consider the possibility of an underlying disease and carry out early investigations accordingly.
日医大医会誌 2020; 16(3), 155-159
Key words
intussusception, malignant lymphoma, organic lesions
Correspondence to
Takahiro Ueda, MD, PhD, Department of Pediatrics, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
E-mail：yuri878t@nms.ac.jp
受付：2020年1月7日 受理：2020年2月10日 |
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