急性腹症で発症し，上行・下行結腸に拇指圧痕像を認めたサルモネラ腸炎の1例

Salmonella Enterocolitis Starting as Acute Abdomen and Showing Thumbprinting Sign in the Descending and Ascending Colon, Report of a Case

要旨　患者は18歳，男性．腹痛，下痢，発熱を主訴に近医で内服加療を受けたが，翌日には症状の増悪がみられ，別医を受診した．受診時，右下腹部に著明な自発痛と腹膜刺激症状があり，急性腹症の診断で当院に緊急入院となった．当院受診時のCT・USで回盲部腸管壁の腫大と少量の腹水を認めた．入院後3日目の大腸内視鏡検査では，大腸全域に発赤，びらんが散在し，下行結腸と上行結腸には著明な浮腫がみられ，上行結腸には浅い不整形の潰瘍を認めた．同日行った注腸検査では微小なバリウム斑が大腸全体に多発しており，拇指圧痕像を下行結腸，上行結腸，盲腸，終末回腸に認めた．内視鏡検査の際に行った便汁培養，生検培養でSalmonella typhimuriumが検出され，サルモネラ腸炎と診断した．中心静脈栄養および抗生剤投与を行い，12日間で軽快し退院となった．

　An 18-year-old man was admitted to our hospital with right lower severe abdominal pain, diarrhea, and fever as his chief complaints. On physical examination of the abdomen, there was rigidity and rebound tenderness in the right lower quadrant. Abdominal CT and US showed ascites and marked thicking of the wall in the ileocecal region. On the 3rd day after admission, colonoscopic examination revealed redness and erosion in the rectum and the sigmoid colon, marked edema in the descending and ascending colon, and shallow irregular ulcers in the ascending colon. Barium enema revealed multiple fine barium frecks in the entire colon, and thumbprinting sign in the descending and ascending colon, cecum, and terminal ileum. Salmonella typhimurium was detected by culture of colonoscopically obtained biopsy specimens and liquids of the stool. Through this data we were able to confirm the diagnosis of this case as Salmonella enterocolitis. The patient was successfully treated with antibiotics and hyperalimentation.