びまん性にS状結腸狭窄を来した子宮放線菌症の1例

Diffuse Sigmoid Colon Stenosis Due to Actinomycosis of the Uterus, Report of a Case

要旨　患者は49歳，女性．子宮筋腫の診断で開腹したところ，S状結腸がびまん性に肥厚し，子宮と強固に癒着していたため外科転科となった．注腸でS状結腸に鋸歯状の全周性狭窄を認め，大腸内視鏡でも肛門縁から25cmに結節状の粘膜の変化を認めたが，生検では悪性所見はなかった．以上から，腸間膜脂肪織炎を疑い，低位前方切除術，単純子宮全摘術を施行した．摘出標本で子宮内部に子宮内避妊具（intrauterine device）を認めた．病理組織学的には，子宮筋層内にDruse（菌塊）の形成を認め，S状結腸には炎症性細胞浸潤が存在していた．以上から，子宮放線菌症がS状結腸に波及し，びまん性に狭窄を来したと診断した．

　A 49-year-old woman underwent surgery for a uterine myoma at the department of gynecology. Diffuse thickening of the sigmoid colon with strong adhesions to the uterus was found during laparotomy, so she was referred to the department of surgery for further examination. Barium enema showed a long and severe stenosis of the sigmoid colon. Colonoscopy demonstrated a narrowed lumen with nodules 25 cm from the dentate line. The biopsy specimen revealed no evidence of malignancy. Low anterior resection combined with simple hysterectomy was performed under the diagnosis of mesenteric panniculitis. An intrauterine device was found in the uterus. Histopathologic examination of the surgical specimen showed sulfur granules of actinomyces in the muscular layer of the uterus, and infiltration of inflammatory cells in the sigmoid colon. From these findimgs, we diagnosed diffuse stenosis of the sigmoid colon caused by uterine actinomycosis.