大腸内視鏡検査で診断しえた横行結腸動静脈奇形の1例

Arteriovenous Malformation of the Transverse Colon Diagnosed by Colonofiberscopy, Report of a Case

要旨　患者は55歳，女性．繰り返す下血のため大腸内視鏡検査を施行し，横行結腸に拡張，蛇行した血管と小血管の集簇を認めた．腹部血管造影で拡張，蛇行した血管と静脈の早期還流および動静脈の伴走を認め，動静脈奇形と診断した．部位の確認および多発病変の否定のため術中内視鏡検査（小腸を含めた）を施行後，横行結腸切除を行った．切除標本における血管構築所見では，粘膜下層に多数の小血管を認め，一部が粘膜表層にまで及ぶ所見が確認できた．本症は高齢者に多く，大腸内視鏡検査の普及により今後増加するものと考えられる．

　A 55-year-old female was admitted to our hospital with complaints of intermittent gastrointestinal hemorrhage. The source of bleeding could not be detected by endoscopic and x-ray examinations of the upper GI series and barium enema study. In a colonoscopic examination at our hospital, a cluster of dilated tortuous vessels at the transverse colon was seen. Arteriography of the superior mesentery revealed dilated tortuous arteries and early venous return at the mid-transverse colon. Arteriovenous malformation (AVM) was finally diagnosed.

　Histological examination of the resected specimen demonstrated dilated vessels in the mucosal and submucosal layer. Colonofiberscopy and arteriography are considered to be important diagnostic procedures for AVM of the colon.