大腸血管拡張症の1例

Vascular Ectasia of the Cecum and Ascending Colon, Report of a Case

要旨　患者は39歳の男性．痔瘻と痔核の術後，右下腹部痛と灼熱感が持続し来院した．盲腸から上行結腸に拡張蛇行した血管と赤色斑紋の集簇した病変を認めた．終末回腸とS状結腸にも斑状発赤を認め，大腸血管拡張症と診断した．血管造影では回結腸動脈の末梢で火炎状に拡張蛇行した動脈と静脈への早期還流を認めた．下血や貧血はなかったが，右下腹部痛が持続したため盲腸上行結腸切除術を施行した，組織学的にも粘膜固有層と粘膜下層に拡張した小血管の集簇を認め，粘膜下層では動脈と静脈が隣接し移行が確認できた．大腸内視鏡検査では，1.2％（308/25,576例）に血管拡張症を認めているが，そのうち動静脈奇形として切除したのは本例だけである．その内視鏡所見は特徴的であった．

　A 39-year-old male was admitted with the complaint of right lower abdominal pain. Colonoscopy revealed vascular ectasia with multiple red spots and telangiectasia without bleeding in the cecum and ascending colon. In addition to this, telangiectatic lesions were observed in the terminal ileum and the sigmoid colon. Gastroduodenoscopy revealed a duodenal telangiectatic lesion in the bulb. Superior mesenteric arteriography showed an arteriovenous malformation supplied by branches of the ileocolic artery. Resected specimens showed numerous, small dilated vessels in the mucosa and submucosa, and these histological findings indicated vascular ectasia of the colon.

　In conclusion, colonoscopy is effective for the diagnosis of the vascular disease. The rate of colorectal vascular ectasia was 1.2% (308/25,576) on colonoscopy over a period of 11 years.