石灰化を欠き初期像と考えられた特発性腸間膜静脈硬化症の2例

Early Stage of Idiopathic Mesenteric Phlebosclerosis without Definite Calcification, Report of Two Cases

要旨　〔症例1〕は80歳，男性．便潜血陽性にて下部消化管内視鏡検査を施行された．盲腸から横行結腸にかけて軽度の浮腫状粘膜と青銅色調の粘膜を連続性に認めた．〔症例2〕は52歳，男性．注腸検査にてポリープを疑われ下部消化管内視鏡検査を施行された．盲腸から横行結腸にかけてわずかに粘膜の色調が青く，静脈と考えられる血管の拡張が目立った．20か月後の下部消化管内視鏡検査では，粘膜は青銅色を増すようになっていた．2例とも腹部X線，腹部CTのいずれでも腸管壁周囲に明らかな石灰化像は認めなかった．しかし生検組織では，粘膜固有層の血管周囲に膠原線維が増生していることと，静脈壁にHE染色で染まる無構造物質が沈着していることから，特発性腸管膜静脈硬化症と診断した．この2例は石灰化を欠き，無症状でもあり，本症の初期像を捉えていると考えられた．

　〔Case 1〕 was an 80-year-old male, positive for occult blood in the stool. Colonoscopy revealed slightly edematous, dark-purple mucosa and dilatation of small vessels. In the biopsied specimens, fibrous degeneration of the proper mucosa and fibrotic sclerosis of the venous wall were seen.

　〔Case 2〕 was a 52-year-old male who on Barium enema was suspected of colon polyp. Colonoscopy revealed slightly dark-purple mucosa. After 20 months, deepening of the color of the mucosa and dilatation of vessels on colonic mucosa were observed. In the biopsied specimens findings were the same as these of 〔case 1〕. Idiopathic mesenteric phlebosclerosis is a new entity characterized by obstruction of veins in the intestinal wall and adjacent mesentery. On CT, our two case showed no difinite calcification of the surrounding colonic wall. Furthermore, except for occult blood in the stool, no other clinical symptoms were recognized. Because of this, we considered that our two cases represented the very early stage of idiopathic mesenteric phlebosclerosis.