上腸間膜動脈主幹部閉塞による広範狭窄型虚血性小腸炎の1例

Massive Ischemic Stricture of the Small Intestine Due to Superior Mesenteric Artery Occlusion, Report of a Case

要旨　患者は69歳，男性．主訴は腹痛と水様下痢．急性膵炎を疑い，大量輸液を中心とした保存的加療を行い症状はいったん軽快した．しかし経口摂取開始後に腸閉塞症を呈したため，経口小腸造影および腹部血管撮影を施行した．この結果，上腸間膜動脈主幹部閉塞による広範な狭窄型虚血性小腸炎と診断し，小腸亜全摘術を施行した．本例は腸管の狭窄範囲が4mと極めて長い点が特徴的であった．上腸間膜動脈主幹部の閉塞による広範な狭窄型虚血性小腸炎の報告は極めて少ない．本例は，通常であれば急性期に広範腸壊死に進展しうる病態を免れ，慢性期に虚血性小腸狭窄を生じたまれな症例と考えられた．

　A 69-year-old hypertensive man, suffering from angina pectoris and paroxysmal atrial fibrillation was referred to our hospital, complaining of abdominal pain and watery diarrhea. Serum level of lactate dehydrogenase, amylase, elastase-1, lipase, and trypsin were elevated, while albumin and calcium were reduced. Abdominal computed tomography obtained about 20 hours after the onset of the illness revealed no abnormal findings. He was thought to have acute pancreatitis accompanied by disseminated intravascular coagulation syndrome. Conservative treatment was performed, resulting in improvement of symptoms. About forty days after the onset of the illness, he presented obstructive ileus. Jejunoileography and selective angiography revealed massive ischemic stricture of the small intestine associated with superior mesenteric artery occlusion. Subtotal jejunoileotomy was performed and the effected bowel, measuring about four meter in length, was resected. This case of ischemic stricture of the small intestine was unique because the affected bowel was very long, reflecting occlusion of the main trunk of the superior mesenteric artery. Massive ischemic stricture of the small intestine caused by truncal obstruction of mesenteric vessels, as in this case, is thought to be a very rare condition.