虚血性変化を伴った広範囲大腸腸間膜脂肪織炎の1例

Extensive Mesenteric Panniculitis with Ischemic Change, Report of a Case

要旨　患者は66歳，男性．難治性の下痢を主訴に来院した．注腸X線検査で横行結腸から直腸Raまでやや腸間膜側に目立つ腸管の狭小化を認め，大小不同の拇指圧痕様所見も認めた．大腸内視鏡検査では，横行結腸，下行結腸，直腸にかけやや片側性に浮腫を伴った管腔の狭小化と腫大した横ひだ所見を認めた．腹部CT所見上，腸管の浮腫とその周囲に脂肪と同程度の低吸収を広範に認めた．病変は広範で悪性疾患を否定できないこともあり確定診断のため腹腔鏡検査を施行した．結腸間膜に固着した変性脂肪垂を採取し病理診断にて本症と診断した．IVH，抗生剤などで保存的に治療したが虚血性変化による大量下血を伴った．そのため病変腸管の切除を目的に開腹したが血管処理困難のため切除を断念し人工肛門を造設した．その後，臨床症状は改善傾向にあったが，術後16日目に腹痛が再燃したためステロイドおよび免疫抑制剤を使用し症状の改善を認めた．

　A 66-year-old male visited our hospital complaining of diarrhea. X-ray inspection revealed rather conspicuous narrowing of the intestinal tract from the transverse colon to the rectum Ra, seeningly due to a disorder of the mesentery. Acupressure marks were also observed.

　In large-intestine endoscopy, narrowing accompanied by edema and big horizontal pleats were viewed in the transverse colon, the descending colon and the rectum.

　Edema of the intestinal tract was observed on the CT view of the abdomen and, in the circumference, there was extensive evidence of tissue with fat-like low density.

　The over-all pathological change was wide-spread and, since the presence of a malignant disease could not be denied, laparoscopic inspection was decided on for the sake of arriving at a definite diagnosis. The un-natural fat which adhered to the mesocolon was extracted and the pathological diagnosis of mesentric panniculitis was made.

　Although on-going observation was carried out in conjunction with IVH and antibiotic treatment, the disorder was accompanied by the extensive blood in the stool and ischemic change.

　Although an incision in the abdomen was made for the purpose of excision of the ischemic portion of the intestinal tract, blood processing was difficult and it was decided to make an artificial anus.

　Although the treatment seemed suited for the improvement of the patient's clinical condition, stomachache re-occurred from the 16th day after the operation. Eventually, improvement was attained by the use of steroids and immunodepressant.