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要旨 1996年夏にわが国で腸管出血性大腸菌(E.coli O157:H7)に起因する腸炎が流行したが,筆者らはその1年前に,47歳の女性に発症した本症を経験した.自験例では緊急内視鏡検査で右半結腸に著しいびらん,出血,汚い膿状分泌物を認め,粘膜面は暗赤色であり,虚血性腸病変に一致した所見が確認された.この時点で本症を強く疑い,選択培地による糞便培養を行い確定診断に至ったが,早期診断と治療に努めた結果,重篤な状態に陥ることなく治癒した.自験例における内視鏡像,超音波内視鏡像,注腸X線像などの画像はO157腸炎として特徴的であったが,感染性腸炎に対する臨床医の取り組み方についても多くの教訓が得られた.
Enterocolitis caused by Escherichia coli O157: H7 has been the focus of attention since its epidemic in the summer of 1996. However, we had encountered a case of a 47-year-old female one year prior to the outbreak of the epidemic. In our case, emergent colonoscopy revealed the presence of remarkable erosions, hemorrhage, dirty pustular exudates on dark red-colored mucosa on the right side colon. These findings were similar to those of ischemic bowel disease. E.coli O157: H7 infection was strongly suspected, and bacterial culture on a selected medium led to confirmative diagnosis. Consequently, serious complications were able to be avoided by early treatment. Typical findings of imaging modalities were presented.
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