消化管虚血性疾患の比較診断学

Comparative Diagnostics of Ischemic Injuries of the Digestive Tract

要旨　“比較診断学”の理念に基づいて，消化管の一過性虚血性疾患の臨床病理学的特徴を検討した．最も高頻度に遭遇する虚血性大腸炎，まれながら認められる虚血性小腸炎，過去に報告は認めないが部分的脾動脈塞栓術に合併する一過性の虚血性胃病変を対象として比較したが，いずれにおいても縦走潰瘍が共通した臨床所見であった．経過とともに認められる形態変化では，部位に特異的な管腔の大きさと比例するかのように，小腸では中心性管状狭窄に進展することが多く，大腸では偏側性変形や嚢形成が多く，狭窄しても偏側性の要素が残り，胃ではほとんど変化を認めなかった．病理学的には，立ち枯れ壊死や粘膜出血，炎症細胞浸潤など共通所見を認め，部位にかかわらず虚血の確定診断に有用であった．

　Based on the concept of “comparative diagnostics”, which was proposed by Prof. Hikoo Shirakabe, we attempted to clarify the clinicopathologic features of ischemic injuries of the digestive tract. In ischemic colitis, ischemic jejunoileitis and ischemic gastritis following partial splenic embolization, longitudinal ulcer was the most characteristic feature common to all three. Regarding serial morphological changes in these conditions, the differences among the organs were apparent ; concentric stricture in the small intestine, eccentric deformity and sacculation in the colon, and scarce deformity in the stomach. In the pathologic evaluation, such characteristic findings as mucosal necrosis, mucosal hemorrhage, and inflammatory infiltrate were common to all the organs. We should be able to make a diagnosis of ischemic injuries to the digestive tract when these characteristic clinicopathologic findings are obtained.