併存する炎症性ポリープの消長を観察しえた膵炎による大腸狭窄の1例

Colonic Stenosis with Inflammatory Polyps Associated with Pancreatitis, Report of a Case

要旨　患者は51歳，男性．便潜血陽性で行った大腸内視鏡検査で，脾彎曲部にブドウの房状に集簇する炎症性ポリープと浮腫性の狭窄を認めた．6か月後にはポリープと狭窄は消失していたが，その10か月後の注腸X線検査で鋸歯状変化を伴う再度の狭窄所見を認めた．伸展性が良好で粘膜面は浮腫の所見であること，膵炎の既往があることから，膵炎による大腸狭窄の可能性を考えCTを施行したところ，慢性膵炎が下行結腸に波及する像を認めた．保存的治療により，2か月後および4か月後の再検では狭窄は軽減していたが炎症性ポリープの再形成を認めた．膵炎による大腸狭窄で内視鏡像の変化と炎症性ポリープの消長を観察しえたまれな症例と考えられた．

　A 51 year old male visited our clinic because of positive fecal occult blood test. Colonoscopy showed grape-shaped aggregated inflammatory polyps and edematous stenosis in the splenic flexure. Biopsy specimens revealed infiltration of inflammatory cells but no evidence of malignancy. 6 months later, endoscopic examination showed disappearance of those polyps and stenosis. However, 10 months later, barium enema demonstrated the reappearance of stenosis with marginal serration in the splenic flexure. Distension of the lumen was good and mucosal surface seemed edematous in endoscopy. Since the patient had a past history of pancreatitis, we examined abdominal CT which exposed extension of pancreatitis to the descending colon. After conservative therapy, the stensosis decreased, but the inflammatory polyps relapsed. It was considered to be a rare case that showed changes in endoscopic features, and development and disappearance of inflammatory polyps in colonic stenosis associated with pancreatitis.