慢性的経過を呈した右側狭窄型虚血性大腸炎の1例

Chronic Ischemic Colitis Causing Stenosis, Report of a Case

要旨　患者は67歳，女性．主訴は持続性下痢．1986年9月ごろより主訴出現，同年12月当院受診．内視鏡検査で横行結腸肝彎曲部近傍の腸管の著明な狭小化，全体の浮腫状変化がみられ，同日施行の注腸検査でも上行結腸肝彎曲部近傍の高度の狭窄，屈曲変形が著明で，辺縁の不整拇指圧痕像，縦走潰瘍が認められた．病理組織学的には回腸末端から下行結腸まで漿膜下～腸間膜の主として静脈の内腔狭窄による閉塞と静脈壁血栓形成，およびその器質化，石灰化をみた．また狭窄腸管壁内では静脈の走行異常とその閉塞が著明であった．

　A 67-year-old female who had persistent diarrhea of 4 months' duration was admitted to Koyama Clinic in December, 1986. Endoscopic examination revealed marked stenosis and edematous change of the transverse colon near the hepatic flexure. The barium enema examination which was performed following endoscopy on the same day also revealed the stenosis of the ascending colon near the hepatic flexure which was markedly deformed, an irregular thumb-printing sign on the border of the stenosis, and a transverse ulcer. Histopathological examination of the obtained specimen disclosed obliterated lumen due to stenosis of the vessels, mainly veins, and organized thrombi with calcification in the arteries of the subserosal to mesenteric area involving terminal ileum through descending colon.