潰瘍性大腸炎を合併した特発性腸間膜静脈硬化症の1例

Idiopathic Mesenteric Phlebosclerosis Concommitant with Pancolitis Type Ulcerative Colitis, Report of a Case

要旨　患者は30歳代，男性．下痢，血便にて当院を受診した．大腸内視鏡検査にて全大腸にびまん性の浮腫，潰瘍を認め，全大腸炎型の潰瘍性大腸炎（UC）と診断し，強力静注療法にて入院加療し緩解導入した．腹部単純X線写真では上行結腸に垂直に走行するひも状の石灰化像を多数認め，CTにおいても腸壁および腸間膜静脈分枝の石灰化像が認められた．大腸内視鏡検査では直腸はUCの緩解粘膜であったが，上行結腸の粘膜は浮腫状で暗緑色を呈し，毛細血管の増生を認めた．注腸X線検査にて，上行結腸の凹凸と浮腫状粘膜を認めた．病理組織所見では，UCの活動性の像を呈さず，粘膜間質の血管壁と粘膜筋板にCongo red染色陰性で好酸性無構造の沈着物が認められ，石灰化は呈していなかった．以上の所見から特発性腸間膜静脈硬化症と診断した．本例では10年にわたる漢方薬（清上防風湯^®）の服用歴があり，病因との関連性も示唆された．特発性腸間膜静脈硬化症に起因する症状は認めないため，外来でUCの緩解維持療法を継続中である．

　A 30-year-old male was admited with the complaint of diarrhea and bloody stool. Colonoscopy revealed that there was diffuse edema and shallow ulcerations in the entire colon and diganosed as pancolitis type ulcerative colitis. He was treated with an intensive intravenous regimen steroid therapy and obtained clinical quiescence. Plane abdominal X-ray examination and CT scan revealed that there were multiple string-like calcifications along the right colon and mesenterium. Repeated colonoscopy showed quiescent mucosa in the rectum but dark green colored mucosa with edema and telangiectasia in the right colon. Barium enema study delineated uneven and edematous mucosa in the right colon. Histopathological findings taken from the right colon revealed the quiescent mucosa as ulcerative colitis and there was acidphilic substance deposition with negative Congo red stain in the interstitial vascular wall of the mucosa and muscularis mucosae, but calcification was not detected. Histopathological diagnosis was idiopathic mesenteric phlebosclerosis. He had a 10-year history of taking a herbal medicine（Sei Jyo Boh Hoo Toh）and it is suggested that this herbal medicine is somehow related to the pathogenesis of idiopathic mesenteric phlebosclerosis. The patient complained of no symptoms due to idiopathic mesenteric phlebosclerosis so maintenance therapy for ulcerative colitis is continuing in the out-patient clinic.