上腸間膜静脈血栓による右側結腸狭窄型虚血性大腸炎の1例

Stricture Type Ischemic Colitis of the Ascending Colon due to Superior Mesenteric Venous Thrombosis, Report of a Case

要旨　患者は62歳，男性．上腹部痛で入院した．注腸X線造影所見では上行結腸に約10cmの限局性の狭窄があり，壁の伸展性が失われて拇指圧痕の所見を認めた．縦走潰瘍も存在し，粘膜面には小びらんが散在した．絶食，点滴で加療するも発症後24日目には盲腸から上行結腸の狭窄は前回より進行しさらに69日目には，バリウムがわずかに通過する程度になっていた．偽憩室様変化も著明になり手術を施行した．上行結腸の壁肥厚，硬化を認め粘膜面はびらんと浅い潰瘍を認めた．血管造影で上腸間膜静脈に血栓を認め，上腸間膜静脈血栓により発症した右側結腸の狭窄型虚血性大腸炎と判明した．狭窄に移行する過程を経時的に画像で確認できた．

　The patient was a 61-year-old man who was admitted due to upper abdominal pain. Poor distension of the ascending colon and irregular thumbprinting was noted on barium enema radiologic examinaion. A longitudinal ulcer and small ulcers were also noted.

　The patient was treated by fasting and drip, but stenosis developed 24 days after the first onset of pain.

　Pseudo-diverticular deformities were revealed on barium enema examination 69 days after the first onset of pain and the patient underwent right hemicolectomy.

　Macroscopically, the wall of the colon was thick and hard and there were irregular shallow ulcers in the ascending colon. The findings and clinical course in this case led to the diagnosis of ischemic colitis, stricture type, due to thrombus in the superior mesenteric vein.

　Barium enema was useful for revealing the stricture in this case.