| 特集名 | 知っておくべき疾患 --十二指腸 | |
|---|---|---|
| 題名 | 十二指腸重複症 | |
| 発刊年月 | 2000年 08月 | |
| 著者 | 野口 剛 | 大分医科大学第二外科 |
| 著者 | 内田 雄三 | 大分医科大学第二外科 |
| 【 要旨 】 | 消化管重複症は嚢胞状(球状)あるいは管状を呈し，全消化管のどの部位にも発生しうるが，十二指腸に発生するものは少なく，本邦文献では4.7%(奥田ら)と報告されている，十二指腸重複症は十二指腸第1部，第2部の内側(時には膵内)に発生するものが多く，総胆管や膵管(多くは副膵管)と合流するものがある．嚢胞内に胃粘膜を有するものでは，嚢胞壁に潰瘍形成や出血がみられることがある．超音波検査で上腹部の嚢胞性腫瘤が，内視鏡検査では粘膜下腫瘤の像がみられる．血管造影，CT,MRIでは嚢胞壁の性状のみならず隣接臓器とのより明確な所見を得ることができる．治療としては，発癌の可能佳もあるので切除が行われる．marsupializationは避けるべきである． | |
| Theme | Digestive Diseases to Know --Duodenum | |
|---|---|---|
| Title | Duplication of the Duodenum | |
| Author | Tsuyoshi Noguchi | Department of Surgery II, Oita Medical University |
| Author | Yuzo Uchida | Department of Surgery II, Oita Medical University |
| [ Summary ] | "Duplication of the alimentary tract" is a concept suggested by Ladd and Gross. The duodenum is an uncommon site for the occurrence of duplication, accounting for 4.7% of such anomalies in Japanese literature, by Okuda. Duplication of the duodenum is more commonly found as a spherical cystic lesion on the medial wall of the first or second parts of the duodenum, sometimes in the pancreatic head, but in rarer cases as a tubular structure, extending up into the thorax, similar to a very long diverticula. Duplication cysts arising from the second parts of the duodenum, are frequently incorporated into the bile duct and the pancreatic duct. In such cases, symptoms of severe pancreatitis are observed. In some cases, the cystic walls are lined with gastric mucosa, causing ulceration and bleeding. Duodenal cysts may be detected with a barium series. A US. endoscopic examination frequently reveals an elevated submucosal cystic tumor. Angiography, CT scans and MR imaging can give more exact information in relation not only the cystic wall, but also to the adjacent organs. In the majority of cases, the treatment of choice is resection of the duplication and the adjacent duodenal wall made necessary because of carcinogenesis. |
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