出血性小腸疾患の診断―そのほか─膠原病，全身疾患，憩室性疾患など

Enteroscopic Diagnosis in Hemorrhagic Small Intestinal Diseases : Miscellaneous Diseases

要旨　原因不明の消化管出血に対してカプセル内視鏡（VCE）およびダブルバルーン内視鏡（DBE）を施行した117例のうち，血管性病変と腫瘍性病変以外の小腸疾患について内視鏡所見を遡及的に検討した．その結果，特発性虚血性小腸炎，Behçet病，放射線性小腸炎，門脈圧亢進症性小腸症，およびMeckel憩室が小腸出血性病変の原因として重要と考えられた．特発性虚血性小腸炎は全周性区域性潰瘍を特徴とし，急速な管腔狭小化を伴っていた．Behçet病に伴う出血性病変は多発する円形潰瘍を特徴としていた．放射線性腸炎では絨毛萎縮と血管拡張を認めた．門脈圧亢進症性小腸症では血管拡張のみならず浮腫状粗糙粘膜が特徴的であった．一方，VCEのみでMeckel憩室を診断することは困難で，X線とDBEが診断に有用であった．出血性小腸疾患の原因として，これらの記病変もその原因となり得ることを念頭に置いた慎重な診断が望まれる．

　Using the retrospective analysis of 117 patients with obscure gastrointestinal bleeding, we selected five specific conditions of possible small intestinal hemorrhage : Idiopathic ischemic enteritis, Behçet disease, radiation-induced enteropathy, portal hypertensive enteropathy, and Meckel's diverticulum. In this article, enteroscopic findings of such conditions have been described. Briefly, circumferential ulcer with the rapid development of intestinal stricture is characteristic of idiopathic ischemic enteritis. Multiple oval ulcers were identified in Behçet disease, whereas, atrophic villi and angiodysplastic lesions were endoscopically observed in radiation-induced enteropathy. As for radiation-induced enteropathy, edematous coarse mucosa with concomitant angiodysplastic lesions seemed to be specific findings under video capsule endoscopy. The detection of Meckel's diverticulum under video capsule endoscopy was considered to be relatively difficult, but, radiography and double-balloon endoscopy can be assumed to be useful for its diagnosis. Since miscellaneous diseases can be the cause of small intestinal hemorrhage, diagnosis should be made with great care in daily clinical practice.