狭窄型虚血性小腸炎の1例

Ischemic Enteritis with Stenosis, Report of a Case

要旨　患者は60歳代，男性．高血圧の既往あり．2009年1月肺炎および心不全，心房細動にて緊急入院した．治療により全身状態は改善したが，経口摂取を開始後より腹痛，嘔吐が出現し腸閉塞と診断した．イレウス管造影では回腸に高度狭窄を認め，造影剤はわずかに流れる程度であった．経肛門小腸内視鏡で回腸遠位部に狭窄と腸管膜付着部対側の縦走潰瘍を認め，潰瘍底は顆粒状を呈していた．保存的治療にて改善せず，回腸部分切除を施行．病理検査にて虚血性小腸炎と診断した．虚血性小腸炎の内視鏡所見についての報告は少ない．本症例で認めた腸管膜付着部対側の縦走潰瘍は本疾患に特徴的と考えられた．また潰瘍底の顆粒状変化は強い肉芽性変化を示しており，保存的治療の限界を示唆する所見と思われた．

　A male aged over 60 years was admitted to Teikyo University Hospital in January, 2009, because of respiratory failure due to pneumonia, heart failure and atrial fibrillation. After intensive care was his general condition had improved, but he presented abdominal symptoms such as pain and vomiting. Abdominal CT showed intestinal dilatation due to stricture of the terminal ileum. Endoscopic examination using the single balloon method demonstrated severe stenosis associated with longitudinal ulceration of the ileum located at the opposite side of the mesentery. He underwent surgical resection that revealed the lesion as ischemic enteritis. Although the number of reported cases with ischemic enteritis is increasing, information about the endoscopic findings of ischemic enteritis is scarce. A longitudinal ulcer at the opposite side of the mesentery seemed a characteristic presentation of the disease. Large granular appearance seen at the ulcer bed was granulation tissue, which was thought to be a sign indicating limitation of conservative treatment.