右卵管癌を疑った審査腹腔鏡手術によりMeckel憩室癌の早期発見につながった１例

抄録

　Meckel's diverticulum, a rare congenital intestinal abnormality occurring in 0.3-2.9％ of the population, is rarely associated with carcinoma and typically diagnosed at an advanced stage with poor prognosis. We present a case of early stage Meckel's diverticulum carcinoma incidentally discovered in a 73-year-old woman. Initially suspected of right fallopian tube carcinoma based on pelvic MRI findings of a tubular structure in the lower abdomen, further investigation through diagnostic laparoscopy was conducted. The patient, never pregnant and menopausal since age 55, had a medical history of cataracts, colonic diverticulitis, diverticular hemorrhage, and reflux esophagitis. Despite the absence of significant symptoms, MRI results suggested malignancy. A contrast-enhanced CT scan suggested a highly mobile lesion, leading to suspicion of a right fallopian tube lesion. PET-CT results were inconclusive, leading to the decision for laparoscopy. This revealed normal uterine, fallopian tube, and appendix conditions, but a small intestinal lesion was noted. Following a gastroenterological consult, a laparoscopically assisted small bowel resection and D1 dissection were performed. Histopathological examination led to diagnosis of Meckel's diverticulum carcinoma (pT2N0M0, Stage I). This case illustrates the necessity of considering gastrointestinal diseases when well-migrated tubular lesions are detected in the pelvis, highlighting the utility of review laparoscopy for early detection.