河合 智之

We report three cases in which umbilical endometriosis developed after a laparoscopic subtotal hysterectomy (LSH) for uterine myoma without endometriotic lesions.<BR>Case 1: A 36-year-old, gravida 2, para 2 underwent an LSH for uterine myoma. Removal of the uterus was performed using the peeling technique with an umbilical trocar. Twelve months postoperatively, induration appeared at the umbilical region (approximately 20 mm) and the right trocar region (approximately 5 mm). Therefore, a lumpectomy was performed 18 months after the initial surgery. The pathologic diagnosis was heterotopic endometriosis. Because the umbilical tumor relapsed 27 months following surgery, Dienogest was administered; eight months later, the tumor had resolved. The umbilical tumor reappeared two months after terminating the orally administered treatment; therefore, resection of the umbilical tumor was performed 55 months after the initial surgery.<BR>Case 2: A 44-year-old gravida 3, para 2 underwent an LSH for uterine myoma. The tumor was morcellated using a morcellator, then extracted using an umbilical trocar. Approximately 19 months postoperatively, an approximately 18 mm area of induration appeared near the umbilical region; therefore, a resection was performed. The pathological diagnosis was heterotopic endometriosis.<BR>Case 3: A 45-year-old gravida 2, para 2 underwent an LSH and left salpingectomy for a uterine myoma and left paraovarian cyst. The hysterectomy involved morcellation and extraction through the umbilical region. An approximately 46 mm area of induration with hemorrhage appeared in the umbilical region 70 months postoperatively. Due to the suspicion of an umbilical tumor, a needle biopsy was performed at the site; the pathologic diagnosis was heterotopic endometriosis. She is currently receiving Dienogest treatment as an outpatient, and is being followed-up with the possibility of surgical extraction in mind.<BR>Conclusion: Although endometriosis is a common gynecological disease, umbilical endometriosis is rare. Therefore, the disease that developed in these three cases was likely due to growth of endometrial tissue in the umbilical region at the time of tissue removal.

症例1(31歳、0経妊0経産婦)。症例2(35歳、1経妊1経産婦)。症例3(28歳、1経妊1経産婦)。3症例とも子宮筋腫に対する腹腔鏡下手術目的に受診となった。いずれの症例も術前検査にて子宮は正常形態を保ち、漿膜下および筋層内に筋腫は認められなかった。だが、腫瘤は子宮に近接しており、周囲臓器と強固な癒着を形成していたため臓器圧迫症状があった。以後、腹腔鏡下手術を行なったところ、腫瘤の癒着剥離操作により腫瘤は速やかに虚血性変化を示した。尚、病理検査では中心性壊死が認められ、臨床経過と総合し、PM(骨盤内腫瘤)の自然発生が考えられた。