虚血性腸炎を併発した大腸腸間膜脂肪織炎の1例

Mesenteric Panniculitis with Ischemic Intestinal Lesion, Report of a Case

要旨　患者は57歳，女性．左下腹部痛で来院し，左下腹部に手拳大の腫瘤を触知した．注腸X線検査では，下行結腸からS状結腸にかけて拇指圧痕像と偏側性の鋸歯状の不整像を認め，内視鏡検査では著明な浮腫状隆起のため，狭窄が直腸から高度であった．CTではS状結腸から下行結腸にかけて腸管の浮腫とその周囲の腸間膜が低吸収領域を示した．以上から大腸腸間膜脂肪織炎と診断した．手術で脾彎曲から直腸の腹膜翻転部まで腸間膜は硬結し，腸管壁の浮腫硬化も著明であった．腸管粘膜は広範な出血性壊死とともに，明らかな線状潰瘍も認められた．病理組織所見は活動（急性）期虚血性腸炎を併発した大腸腸間膜脂肪織炎に相当した．

　A case of mesenteric panniculitis seen in a 57-year-old woman is reported. The patient complained of left lower abdominal pain and diarrhea.

　Physical examination revealed a hard fist-sized mass with tenderness in her LLQ area. Laboratory findings on admission were normal except for positive CRP and increased ESR. Barium enema study demonstrated narrowing of the sigmoid and descending colon and sawtooth-like appearance on its mesenteric side. Colonoscopic examination showed narrowing and edema of the rectosigmoid and descending colon. The CT scan and EUS revealed edema of the rectosigmoid colon surrounded by fatty tissue.

　Resected specimen showed submucosal edema, focal mucosal necrosis, and a lineal ulcer suggestive of an intestinal ischemic lesion.

　Pathological examination of the resected colon yielded a diagnosis of mesenteric panniculitis with an ischemic intestinal lesion.