虚血性腸炎の所見を合併したS状結腸腸間膜脂肪織炎の1例

Mesenteric Panniculitis with Ischemic Lesion, Report of a Case

要旨　患者は73歳，男性．排便困難を主訴に来院した．注腸X線検査でS状結腸に限局した狭窄を認め，内腔には肥厚したアコーディオンひだ様の所見を認めた．内視鏡所見では，発赤腫脹した輪状の粘膜ひだを認めたが，その中には潰瘍や腫瘤はみられなかった．CT，EUS，MRI所見上，S状結腸を取り巻く脂肪織の肥厚を認め，腸間膜脂肪織炎と診断された．経静脈栄養および抗生剤を投与し経過を観察したが，改善傾向は認められず，外科的手術のため転院した．初回から5週後の注腸二重造影像では，特に症状の変化はみられなかったが，栂指圧痕や粘膜の剝離など虚血性腸炎の所見の合併を認めた．切除標本では，S状結腸の壁の肥厚，潰瘍形成を伴う内腔の狭細化が認められた．病理組織学的所見では，肥厚した漿膜，腸間膜の脂肪織に脂肪織炎の所見がみられ，また，Ul-IIの潰瘍，粘膜内の充血，粘膜下層以下の系統的な静脈壁の肥厚などがみられ虚血性腸炎の所見を伴った腸間膜脂肪織炎と診断された．

　A 73-year-old male having difficulty with defecation was admitted to the anorectal clinic. Double contrast radiography demonstrated a localized stricture with an accordion pleat-like appearance of swollen, mucosal folds in the sigmoid colon. Colonoscopy revealed reddish, swollen, circular mucosal folds in the lumen without ulcerations and masses. Malignancy was negative in the biopsy specimen and CT, endoscopic ultrasonography and MRI revealed the thickened fatty tissue. Due to these findings mesenteric panniculitis in the sigmoid colon was diagnosed. After treatment with TPN and antibiotics for two weeks, no improvement was found of the inflammatory findings in the barium enema radiography. He was referred to the University hospital for surgery. On the third colonography after five weeks from the first examination, an ischemic pattern like thumbprinting and lack of mucosa was demonstrated in the more strictured sigmoid colon without symptoms of ischemia. The surgical specimen showed the thicken wall and narrowed lumen and the lack of mucosa on the sigmoid colon. Hypertrophy of the serosal, mesenteric fatty tissue with inflammation and mucosal ulceration, hyperemia and thickening of the venous wall confirmed the diagnosis of mesenteric panniculitis associated pathologically with ishemic change.