虚血性腸炎を繰り返したSLE（systemic lupus erythematosus）の1例

SLE (Systemic Lupus Erythematosus) Complicated by Recurrent Ischemic Enteritis, Report of a Case

要旨　患者は54歳，女性．1年前より腹痛発作を繰り返していたが，1998年4月7日高度の腹痛が出現し当院受診．腹部CTにて高度腹水貯溜と小腸の高度の全周性浮腫像を認めたため緊急開腹を施行した．開腹時所見では，Treitz靭帯から約50cmの部分より220cmの長さにわたり著明な腸管の充血および腫脹を認めたが，穿孔および狭窄はなく腸切除は行わなかった．血清学的に抗核抗体強陽性，低補体価，抗二本鎖DNA抗体高値，白血球減少，日光過敏症よりSLE（systemic lupus erythematosus＞と診断した．術後経過は良好であったため，ステロイド投与をせずに経過観察していたが，5月9日，突然腹痛を訴えたため，腹部CTおよび注腸X線を施行し，下腸間膜動脈灌流領域の虚血性大腸炎と診断された．SLEに伴う虚血性腸炎の合併は比較的まれであるが，一般的な虚血性腸炎とは発生部位・経過が異なることより，SLEの病態と直接関連したものと考えられた．

　The patient was a 54-year-old woman who had experienced recurrent attacks of abdominal pain for one year. On April 7, 1998, the patient consulted our hospital because of severe abdominal pain. Abdominal CT demonstrated the presence of severe ascites retention and severe edematous images over the entire circumference of the small intestine. Because of these findings, emergency laparotomy was performed. Findings on laparotomy showed marked congestion and swelling covering 180 cm of the intestine, beginning from the region approximately 10 cm distant from Treitz's ligament. However, enterectomy was not performed because of the absence of perforation and stenosis. Postoperative serological examinations demonstrated a potent positivity against antinuclear antibody, low complement titers, higher levels of anti-double-stranded DNA antibody, and the presence of leukocytopenia and photosensitivity. This led to the diagnosis of SLE (systemic lupus erythematosus). Because the patient made satisfactory progress, the postoperative course of this patient was not followed up with administration of steroids. On May 9, 1999, abdominal CT and contrast enema were performed because of a sudden complaint of abdominal pain, and the diagnosis of ischemic colitis at the area of reflux of the inferior mesenteric artery was established.

　The complication of SLE by ischemic enteritis is relatively rare and the region of the development and the course of ischemic enteritis associated with SLE differ from those of general ischemic enteritis. Therefore, it is considered that complication of SLE by ischemic enteritis is directly related to the pathologic condition of SLE.