虚血性大腸炎を合併したS状結腸子宮内膜症の1例

Intestinal Endometriosis of the Sigmoid Colon Associated with Ischemic Colitis, Report of a Case

要旨　虚血性大腸炎を合併したS状結腸子宮内膜症の1例を報告する．患者は45歳の女性で，月経時に腹痛と下血で発症した．大腸内視鏡検査では下行結腸に縦走潰瘍と潰瘍周囲の発赤を伴う浮腫状粘膜を，また，注腸X線検査では下行結腸に管腔の狭小化と拇指圧痕像を認め，虚血性大腸炎と診断した．その後の注腸X線検査でS状結腸に粘膜下腫瘍を疑わせる腫瘤状陰影を，また大腸内視鏡検査ではS状結腸に約半周性の粘膜下腫瘤様隆起と粘膜ひだの収束像を認め，虚血性大腸炎を合併したS状結腸粘膜下腫瘍と診断し開腹術を施行した．術中所見で腸管子宮内膜症と診断され，虚血性大腸炎の発症への関与が示唆された．

　A 45-year-old woman was admitted because of melena and abdominal pain during her menstrual period. Initial colonoscopic examination showed longitudinal ulcers and reddish edematous change of the mucosa, and barium examination showed narrowing of the lumen and thumbprinting in the descending colon, which in the second examination, turned out to be filling defect. Colonoscopy showed an elevated lesion and luminal narrowing in the sigmoid colon. These findings suggested that a submucosal tumor of the sigmoid colon had induced ischemic colitis in the descending colon. A partial resection of the sigmoid colon was undertaken. Pathological examination revealed intestinal endometriosis. We postulated that the intestinal endometriosis may have been the cause of ischemic colitis.