MRI検査および超音波検査が有用であった肛門部子宮内膜症の1例

症例は40歳の女性.2回の経膣分娩と会陰切開歴あり.肛門部の会陰切開痕に月経時に痛みを伴う硬結を認め,痔瘻を疑われ当院を紹介された.肛門部超音波検査ならびにジャックナイフ位MRI検査で10時方向の浅外肛門括約筋の外側尾側部に病変を認めた.外科的に完全に切除したが,肛門括約筋形成術は施行しなかった.病理は子宮間質と子宮腺管を認め,子宮内膜症であった.術後便失禁は認めなかった.会陰切開時の機械的移植による発生機序が想定された.鑑別診断や肛門括約筋迷入の評価に超音波検査とMRIは有用である....

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Published in日本大腸肛門病学会雑誌 Vol. 69; no. 4; pp. 227 - 230
Main Authors 荒木, 吉朗, 加川, 隆三郎, 友井, 正弘, 安井, 寛
Format Journal Article
LanguageJapanese
Published 日本大腸肛門病学会 2016
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ISSN0047-1801
1882-9619
DOI10.3862/jcoloproctology.69.227

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Abstract 症例は40歳の女性.2回の経膣分娩と会陰切開歴あり.肛門部の会陰切開痕に月経時に痛みを伴う硬結を認め,痔瘻を疑われ当院を紹介された.肛門部超音波検査ならびにジャックナイフ位MRI検査で10時方向の浅外肛門括約筋の外側尾側部に病変を認めた.外科的に完全に切除したが,肛門括約筋形成術は施行しなかった.病理は子宮間質と子宮腺管を認め,子宮内膜症であった.術後便失禁は認めなかった.会陰切開時の機械的移植による発生機序が想定された.鑑別診断や肛門括約筋迷入の評価に超音波検査とMRIは有用である.
AbstractList 症例は40歳の女性.2回の経膣分娩と会陰切開歴あり.肛門部の会陰切開痕に月経時に痛みを伴う硬結を認め,痔瘻を疑われ当院を紹介された.肛門部超音波検査ならびにジャックナイフ位MRI検査で10時方向の浅外肛門括約筋の外側尾側部に病変を認めた.外科的に完全に切除したが,肛門括約筋形成術は施行しなかった.病理は子宮間質と子宮腺管を認め,子宮内膜症であった.術後便失禁は認めなかった.会陰切開時の機械的移植による発生機序が想定された.鑑別診断や肛門括約筋迷入の評価に超音波検査とMRIは有用である.
Author 加川, 隆三郎
友井, 正弘
安井, 寛
荒木, 吉朗
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  fullname: 友井, 正弘
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  fullname: 安井, 寛
  organization: 洛和会音羽病院病理診断科
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References 12) Schickele M: Les pseudolipomes du ligament large. Bull Mem Soc Anat Paris 20:603-605, 1923
8) Sayfan J, Benosh L, Segal M, et al: Endometriosis in episiotomy scar with anal sphincter involvement. Dis Colon Rectum 34:713-716, 1991
16) 松岡 歩, 寺田美里, 山縣麻衣ほか:腫瘍切除後に再発し, 感染を合併した会陰切開部子宮内膜症の1例. 関東産婦誌 49:589-593, 2012
7) Gordon PH, Schottler JL, Balcos EG, et al: Perianal endometrioma: report of five cases. Dis Colon Rectum 19:260-265, 1976
17) 中山真紀, 黒川正人, 佐藤 誠ほか:会陰部に発生した異所性子宮内膜症の1例. 形成外科 54:547-551, 2011
2) Martínez Hernández-Magro P, Villanueva Sáenz E, Alvarez-Tostado Fernández F, et al: Endoanal sonography in the assessment of perianal endometriosis with external anal sphincter involvement. J Clin Ultrasound 30:245-248, 2002
15) 加川隆三郎, 野村英明, 友井正弘:肛門疾患の画像診断-深部痔瘻に対するジャックナイフ位MRI法-. 臨外 63:61-70, 2008
5) Chen N, Zhu L, Lang J, et al: The clinical features and management of perineal endometriosis with anal sphincter involvement: a clinical analysis of 31 cases. Human Reproduction 27:1624-1627, 2012
9) Liang CC, Tsai CC, Chen TC, et al: Management of perineal endometriosis. Int J Gynecol Obstet 53:261-265, 1996
18) Barker PG, Lunniss PJ, Armstrong P, et al: Magnetic resonance imaging of fistula-in-ano: technique, interpretation and accuracy. Clin Radiol 49:7-13, 1994
1) Bacher H, Schweiger W, Cerwenka H, et al: Use of anal endosonography in diagnosis of endometriosis of the external anal sphincter. Dis Colon Rectum 42:680-682, 1999
3) Watanebe M, Kamiyama G, Yamazaki K, et al: Anal endosonography in the diagnosis and management of perianal endometriosis: report of a case. Surg Today 33:630-632, 2003
6) Prince LN, Abrams J: Endometriosis of the perineum: Review of the literature and case report. Am J Obstet Gynecol 73:890-893, 1957
11) Paull T, Tedeschi LG: Perineal endometriosis at the site of episiotomy scar. Obstet Gynecol 40:28-34, 1972
10) 前田耕太郎, 橋本光正, 片井 均ほか:肛門括約筋に及んだ会陰部子宮内膜症の1例. 日本大腸肛門病会誌 46:891-894, 1993
13) Dougherty LS, Hull T: Perineal endometriosis with anal sphincter involvement. Dis Colon Rectum 43:1157-1160, 2000
14) 飯野好明, 井尾裕子, 大江英一ほか:会陰切開部に発症した子宮内膜症8例の検討. HORMONE FRONTIER IN GYNECOLOGY 9:422-424, 2002
4) Toyonaga T, Matsushima M, Tanaka Y, et al: Endoanal ultrasonography in the diagnosis and operative management of perianal endometriosis: report of two cases. Tech Coloproctol 10:357-360, 2006
References_xml – reference: 11) Paull T, Tedeschi LG: Perineal endometriosis at the site of episiotomy scar. Obstet Gynecol 40:28-34, 1972
– reference: 8) Sayfan J, Benosh L, Segal M, et al: Endometriosis in episiotomy scar with anal sphincter involvement. Dis Colon Rectum 34:713-716, 1991
– reference: 12) Schickele M: Les pseudolipomes du ligament large. Bull Mem Soc Anat Paris 20:603-605, 1923
– reference: 4) Toyonaga T, Matsushima M, Tanaka Y, et al: Endoanal ultrasonography in the diagnosis and operative management of perianal endometriosis: report of two cases. Tech Coloproctol 10:357-360, 2006
– reference: 6) Prince LN, Abrams J: Endometriosis of the perineum: Review of the literature and case report. Am J Obstet Gynecol 73:890-893, 1957
– reference: 10) 前田耕太郎, 橋本光正, 片井 均ほか:肛門括約筋に及んだ会陰部子宮内膜症の1例. 日本大腸肛門病会誌 46:891-894, 1993
– reference: 18) Barker PG, Lunniss PJ, Armstrong P, et al: Magnetic resonance imaging of fistula-in-ano: technique, interpretation and accuracy. Clin Radiol 49:7-13, 1994
– reference: 17) 中山真紀, 黒川正人, 佐藤 誠ほか:会陰部に発生した異所性子宮内膜症の1例. 形成外科 54:547-551, 2011
– reference: 14) 飯野好明, 井尾裕子, 大江英一ほか:会陰切開部に発症した子宮内膜症8例の検討. HORMONE FRONTIER IN GYNECOLOGY 9:422-424, 2002
– reference: 5) Chen N, Zhu L, Lang J, et al: The clinical features and management of perineal endometriosis with anal sphincter involvement: a clinical analysis of 31 cases. Human Reproduction 27:1624-1627, 2012
– reference: 2) Martínez Hernández-Magro P, Villanueva Sáenz E, Alvarez-Tostado Fernández F, et al: Endoanal sonography in the assessment of perianal endometriosis with external anal sphincter involvement. J Clin Ultrasound 30:245-248, 2002
– reference: 15) 加川隆三郎, 野村英明, 友井正弘:肛門疾患の画像診断-深部痔瘻に対するジャックナイフ位MRI法-. 臨外 63:61-70, 2008
– reference: 9) Liang CC, Tsai CC, Chen TC, et al: Management of perineal endometriosis. Int J Gynecol Obstet 53:261-265, 1996
– reference: 16) 松岡 歩, 寺田美里, 山縣麻衣ほか:腫瘍切除後に再発し, 感染を合併した会陰切開部子宮内膜症の1例. 関東産婦誌 49:589-593, 2012
– reference: 3) Watanebe M, Kamiyama G, Yamazaki K, et al: Anal endosonography in the diagnosis and management of perianal endometriosis: report of a case. Surg Today 33:630-632, 2003
– reference: 13) Dougherty LS, Hull T: Perineal endometriosis with anal sphincter involvement. Dis Colon Rectum 43:1157-1160, 2000
– reference: 1) Bacher H, Schweiger W, Cerwenka H, et al: Use of anal endosonography in diagnosis of endometriosis of the external anal sphincter. Dis Colon Rectum 42:680-682, 1999
– reference: 7) Gordon PH, Schottler JL, Balcos EG, et al: Perianal endometrioma: report of five cases. Dis Colon Rectum 19:260-265, 1976
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Snippet 症例は40歳の女性.2回の経膣分娩と会陰切開歴あり.肛門部の会陰切開痕に月経時に痛みを伴う硬結を認め,痔瘻を疑われ当院を紹介された.肛門部超音波検...
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SubjectTerms MRI
肛門部子宮内膜症
超音波検査
Title MRI検査および超音波検査が有用であった肛門部子宮内膜症の1例
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