特異な形態を呈した大腸の多発潰瘍の1例

Multiple Colonic Ulcers with Atypical Macroscopic Features, Report of a Case

要旨　患者は45歳，男性．ペースメーカー挿入後に発熱・腹痛・下痢が出現．胆嚢炎の診断にて術前に注腸バリウム・大腸内視鏡を施行したところ，横行結腸中部に皺襞のひきつれと片側性狭窄を伴う円～卵円形潰瘍を認めた．びまん浸潤型大腸癌を否定できず胆嚢摘出術とともに横行結腸切除術を行った．切除標本において，結腸間膜紐および対側紐上に並ぶ5個のUl-Ⅳの円～卵円形潰瘍を認め，鉄染色で多数の陽性細胞がみられた．以上から，虚血性大腸病変，潰瘍型，治癒進行期と診断された．成因としては，血栓もしくは塞栓による複数の直動脈あるいは辺縁動脈の閉塞と推察された．

　A 45-year-old man developed fever, abdominal pain and diarrhea after pacemaker-insertion. Barium enema and colonoscopy revealed transverse colon stenosis due to multiple round to oval ulcers with converging mucosal folds. Under the suspicion of scirrhus-type colon cancer, the transverse colon resection was performed. The resected specimen showed five Ul-Ⅳ round to oval ulcers on the tinea. Histochemical study revealed numerous iron-positive cells among the granulated tissue. From these observations, we finally made a diagnosis of ulcerative-type ischemic lesion of the colon at healing phase. We suspected that the cause of the lesion was thrombo-embolism of several vasa recta or marginal arteries.