BACKGROUND Jejunal diverticulosis is an uncommon disease and usually asymptomatic. It can be complicated not only by diverticulitis, but by hemorrhage, perforation, intussusception, volvulus, malabsorption and even small bowel obstruction due to enteroliths formed and expelled from these diverticula. METHODS We describe a case of an occult bleeding jejunal diverticulum, casually discovered in...

症例は28歳の男性．１週間前からの間欠的な腹痛が増悪したため，当院の救急外来を受診した．腹部造影CT検査で腸石を伴うメッケル憩室による腸閉塞を疑い緊急手術を施行した．診断的腹腔鏡で手術を開始し，回腸に腸石が充満した長径８cmのメッケル憩室を認め，憩室から脱落した腸石の一部による腸閉塞と診断した．臍部を小切開しメッケル憩室を含む小腸部分切除術を施行した．腸石の赤外線吸収スペクトラムによる解析では，胆汁酸と類似したスペクトラムが得られ真性腸石と診断した．腸石を伴うメッケル憩室は腸閉塞の原因となることがあり，安全性に配慮した適応の検討は必要であるが腹腔鏡下手術は有効な選択肢となりうる．

INTRODUCTION Enteroliths are an uncommon entity in humans and form a rare cause of subacute intestinal obstruction. They occur proximal to stricture or in a diverticulum or a blind loop due to stasis. CASE DESCRIPTION 40 years male presenting with intermittent right lower abdominal pain since 1 year. Barium meal follow-through and CT abdomen diagnosed as a case of subacute intestinal obstruct...

Afferent loop obstruction caused by enterolith formation is rare and cannot be easily treated with endoscopy because of the difficulty associated with the nonsurgical removal of enteroliths. A 74-year-old woman was admitted with fever and acute abdominal pain. Clinical features and imaging studies suggested afferent loop obstruction caused by an enterolith after Roux-en-Y hepaticojejunostomy. P...

症例は45歳，男性．以前に他院で開腹手術を2回施行していた．それ以降，頻繁に腸閉塞を発症し保存的治療を行っていたため，手術目的に当院を受診した．腸閉塞発症時の腹部CTでは小腸吻合部より口側腸管が著明に拡張し，吻合部内腔に平板状の異物を多数認めた．腹腔鏡下に観察したところ，小腸吻合部が腹壁に癒着し腸閉塞の閉塞起点となっていた．癒着を剥離し，小切開創から吻合部を含む小腸を部分切除した．吻合部は瘢痕狭窄とともに口側が嚢状に拡張し，内部に結石が多数存在していた．結石分析を行い，デオキシコール酸による真性腸石と診断した．術後経過は良好で，術後6日目に退院した．

Solitary diverticulitis of the cecum is a rare condition in the general population (0.17%) (1). In Western countries, diverticular disease occurs mainly in the left colon, with about 2% in the ascending colon (2). Approximately 80% are found on the anterior side of the cecum (3), and men around 40 years of age are predominantly affected. There are 2 types of diverticula: true diverticula, which...