March 3, 2026Open Access

A Small Intestinal Lesion Causing Intestinal Obstruction—A Case of IgG4-related Disease—

Key Points

Intestinal obstruction was addressed through surgical removal of a 20cm segment of the small intestine.
Post-operative findings showed significant lymphocyte and plasma cell infiltration, and a high serum IgG4 level of 1,007 mg/dl.
Histological analysis confirmed IgG4-related disease with characteristic fibrosis and venous occlusion observed.
Patient experienced a smooth recovery, with no new lesions noted during 1 year and 5 months of follow-up.

Abstract

症例は60歳の男性で，心窩部痛を主訴に救急搬送された．来院時腹部造影CTでは骨盤内の小腸に限局性の壁肥厚とその口側の小腸の拡張を認めた．小腸腫瘍による腸閉塞と診断し，イレウス管で減圧後，入院8日目に腹腔鏡補助下小腸部分切除術を施行した．術中所見では狭窄部の小腸は結腸垂と癒着していた．癒着剥離後創外へ引き出し，狭窄部を含めた約20cmの小腸を切除した．切除標本では狭窄部に全周性の潰瘍と壁肥厚を認めたが，明らかな腫瘍性病変は認めなかった．病理組織学的には小腸壁全層に著明なリンパ球，形質細胞の浸潤と線維化を認め，IgG4/IgG陽性細胞比は40％以上，かつIgG4陽性形質細胞が10/HPFを超える箇所を認めた．また，特徴的な花筵状線維化と閉塞性静脈炎の所見を認めた．術後の血液検査では血清IgG4値は1,007mg/dlと高値であった．以上よりIgG4関連疾患と診断した．経過は良好で，術後8日目に退院となった．術後1年5カ月現在，経過観察中であるが新規病変は認めていない．

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Koyo Ikeda

Koichi NAKAHASHI

Takanori Kyokane

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Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

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Mie Chuo Medical Center

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A Small Intestinal Lesion Causing Intestinal Obstruction—A Case of IgG4-related Disease—

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