5年以上にわたって経過を追えた特発性腸間膜静脈硬化症の1例

Serial Endoscopic Changes in Mesenteric Phlebosclerosis, Report of a Case and a Review of the Literature

要旨　患者は68歳，女性．便潜血陽性の精密検査目的で行った大腸内視鏡検査で，右側結腸の粘膜色調異常を指摘された．その後も無症状であったが，5年半にわたって定期的に大腸内視鏡検査を行ったところ，暗青色調粘膜に加えて浮腫と静脈拡張が出現し，その程度が徐々に増強し，さらには発赤やびらんも伴ってきた．最終的に特発性腸間膜静脈硬化症と診断し，現在は保存的に経過観察中である．長期間に及ぶ自験例の内視鏡所見の推移を提示するとともに，本邦から報告された本症60例を加えて集計し，本症の臨床像を解析した．

　A 68-year-old woman consulted an outpatient clinic in our hospital after a positive fecal occult blood test. Initial colonoscopy demonstrated an abnormal mucosal color of the right colon only. Since that time, she underwent periodic colonoscopies during the next 5 years and a half. The second colonoscopy revealed edematous, dark-blue mucosa with dilated capillaries. The third colonoscopy showed varices-like, dilated vessels in the right colon. The latest colonoscopy demonstrated hyperemia, dark-blue edematous mucosa, erosions, and a loss of normal vascular pattern. Based on these pathognomonic endoscopic features, histologic findings of the biopsy samples and calcification of the mesenteric vessels shown on abdominal CT, a diagnosis of idiopathic mesenteric phlebosclerosis was made.

　Details of this case and a review of the literature reported from Japan are described in this article.