Chronic Diverticulitis of the Terminal Ileum Concurrent with a Pedunculated Lypohyperplasia of the Ileocecal Valve

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  • 回盲弁lipohyperplasiaが誘因と考えられた回腸末端多発憩室炎の1例

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An 83-year-old man, who had previously undergone an appendectomy, was seen at our hospital because of a positive reaction on fecal occult blood test. Colonoscopy and a barium enema showed a 30 mm pedunculated mass on the ileocecal valve. The biopsy showed no signs of malignancy. We diagnosed the lesion as lipohyperplasia and the patient was observed regularly in the outpatient clinic, but the patient developed a positive reaction on fecal occult blood test, loose stool and mild pain in the right lower abdomen 6 months later. Computed tomography (CT) examination revealed a fat density mass in the ascending colon and multiple diverticula of the terminal ileum. Operation was performed under the diagnosis of lipohyperplasia of the ileocecal valve and chronic diverticulitis of the terminal ileum. Because the mobilization of ileocecal part was difficult due to the strong adhesion between the ileum end and retroperitoneum, we transfered from laparoscopic assisted surgery to open surgery and performed an ileocecal resection. Histological findings of the specimen revealed multiple diverticulitis of the terminal ileum and ascending colon. Therefore, we believe that the multiple diverticula was formed by the increased internal pressure of the terminal ileum due to mechanical obstruction by lipohyperplasia of the ileocecal valve.

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