下腸間膜静脈の閉塞を伴った腸間膜脂肪織炎の1切除例

Mesenteric Panniculitis Complicated by Occlusion of the Inferior Mesenteric Vein, Report of a Case

要旨　患者は66歳，男性で，腹痛と血便を主訴に入院．注腸X線造影で上部直腸からS状結腸にかけて，辺縁が不整鋸歯状の高度の伸展不良を認め，大腸内視鏡では，粘膜は浮腫が高度で発赤やびらんを伴っていた．腹部CTで，S状結腸周囲の脂肪織濃度の上昇を認め腸間膜脂肪織炎が疑われた．また周囲の下腸間膜動脈に連続する末梢血管の著明な拡張を認めた．腹部血管造影では，下腸間膜静脈が完全閉塞していた．保存的に加療したが腸閉塞症状を認め，S状結腸切除術を行った．病理組織学的には，腸間膜の高度肥厚と炎症所見，動・静脈の閉塞や狭窄を認め，下腸間膜静脈閉塞を伴った腸間膜脂肪織炎と診断した．腸管狭窄が進行した原因として，腸間膜脂肪織炎の変化に加えて，下腸間膜静脈閉塞等による腸循環障害性変化が影響したものと考えられた．

　We present a rare case of mesenteric panniculitis complicated by occlusion of the inferior mesenteric vein.

　A 66-year-old male was admitted to our hospital complaining of abdominal pain and hematochezia. Barium enema examination showed circumferential stricture with irregular rigidity of the colonic mucosa from the upper part of the rectum to the sigmoid colon. Colonoscopy revealed severe mucosal edema accompanied with redness and erosion in the same colonic portion. Abdominal CT showed an elevated fat density level and so mesenteric panniculitis was suspected. Also remarkably dilated peripheral vessels flowing into the inferior mesenteric artery were observed. Angiography revealed complete obstruction of the inferior mesenteric vein. Although the patient had been treated by conservative therapy, the symptom of the intestinal obstruction had gradually increased and surgical resection of the sigmoid colon was performed. Histopathological findings showed severe thickness of the mesentery and mesenteric arteriovenous obstruction/stricture. Thus mesenteric panniculitis accompanied with obstruction of the inferior mesenteric vein was diagnosed.