下腸間膜静脈領域の静脈閉塞による左半結腸巨大潰瘍の1例

Left Hemicolonic Giant Ulcers Due to Venous Occlusion in the Inferior Mesenteric Venous Region, Report of a Case

要旨　患者は71歳，男性．左下腹部痛と血便で入院し，左下腹部に腸詰様の腫瘤を触知した．1か月前には注腸X線造影所見でS状結腸と下行結腸の伸展不良，不整鋸歯状の辺縁を認めた．また大腸内視鏡所見で結腸粘膜は軽度発赤し腫大した半月ひだにより管腔は狭くなっていたが，潰瘍やびらんは認めなかった．入院時には多彩な潰瘍性病変が認められた．下部直腸では不整形の小潰瘍の多発，上部直腸では不整形潰瘍，S状結腸と下行結腸では巨大全周性潰瘍が認められた．絶食と中心静脈栄養で加療したがS状結腸と下行結腸の狭窄を来し手術となった．外科切除標本の検索で下腸間膜静脈領域の静脈内膜肥厚と静脈炎による静脈閉塞が明らかとなった．静脈閉塞による虚血が大腸潰瘍の原因と考えられた．

　The patient was a 71-year-old man. He was admitted because of left lower abdominal pain and hematochezia. On admission a sausage-like tumor was palpated in the left lower abdomen. One month before admission, poor distension of the sigmoid and ascending colon and an irregular sawtooth-like margin were noted on barium enema radiologic examination. Colonoscopic examination revealed that the colonic mucosa was slightly reddened and that the lumen was narrowed by swollen semilunar folds, but was free of ulcer or erosion. On admission the patient was found to have varied ulcerative lesions. Briefly, there were multiple small ulcers of an irregular shape in the lower rectum; there were ulcers of an irregular shape in the upper rectum; and giant circumferential ulcers were noted in the sigmoid and descending colon. The patient was treated by fasting and central venous alimentation, but had to be operated on as indicated by the stenosis of the sigmoid and descending colon. Examination of tissue specimens obtained by surgical resection disclosed that venous occlusion had been caused by the thickening of the venous intima and phlebitis. Ischemia resulting from venous occlusion was regarded as the cause of the colonic ulcers in this case.