21.腸管嚢胞様気腫症

Pneumatosis Cystoides Intestinalis

要旨　腸管嚢胞様気腫症は，腸管壁内の含気性嚢胞を特徴とする疾患で，基礎疾患の有無で特発性と続発性に分類される．成人では無症状のまま偶然発見されることが多いが，腹部膨満，下血，下痢などの症状を契機に発見されることもある．X線検査では，腸管壁に沿った嚢胞状または直線状のガス像が特徴的で，内視鏡所見では頂部に発赤を伴う柔らかい粘膜下腫瘍様隆起を呈する．有症状例では高圧酸素療法や抗生剤投与が試みられる．

　Pneumatosis cystoids intestinalis (PCI) is characterized by multiple gas-filled cysts in the wall of the gastrointestinal tract. PCI is classified into primary and secondary types. Secondary PCI occurs in association with numerous diseases. In addition, PCI can be clinically categorized into fulminant and indolent types. Fulminant PCI occurs in infants with necrotizing enterocolitis. In contrast, indolent PCI tends to occur incidentally in adults and can be managed conservatively. On contrast barium radiography, PCI is characterized by multiple filling defects composed of radiolucent clusters of gas-filled cysts along the bowel wall. Colonoscopy demonstrates multiple submucosal cyst-like lesions of various sizes. Hyperbaric oxygenation or antibiotics have proved to be effective in this disease.