著明な静脈の石灰化を伴った静脈硬化症による虚血性腸病変の1例

Ischemic Intestinal Lesion Caused by Phlebosclerosis with Marked Venous Calcification, Report of a Case

要旨　患者は57歳，男性．2年5か月前から右側腹部痛出現．注腸X線検査で横行結腸から上行結腸にかけて壁の硬化，管腔狭小化および偽憩室様変形を認めた．また，腹部単純X線像で上行結腸に一致して血管の著明な石灰化が存在した．大腸内視鏡検査では横行結腸粘膜に浮腫，発赤が認められ血管透見像は消失していた．また，一部に縦走傾向の潰瘍を有し，管腔は狭小化していた．以上からCrohn病を疑い中心静脈栄養を施行したが症状が消失せず，大腸亜全摘術を施行．病理組織学的所見から，静脈硬化症による虚血性腸病変と診断された．静脈硬化症による虚血性腸病変はまれで貴重な症例と考え報告した．

　A 57-year-old man experienced right abdominal pain in the two years before the admission to the Fukuoka University Chikushi Hospital in August 1984. Barium enema showed sclerosis of the colonic wall, luminal narrowing and pseudo-diverticular formation of the ascending and transverse colon. A plain abdominal x-ray film showed marked tubular calcification of the vascular wall of the ascending colon. Colonoscopic examination showed the edematous and erythematous mucosa with indistinct vascular pattern, scattered longitudinal ulcers and luminal narrowing. Based on the x-ray and endoscopic findings, the patient was tentatively diagnosed with Crohn's disease and was treated with intravenous hyperalimentation. Because his symptom persisted with medical treatments, he underwent a subtotal colectomy. Histological examination of the resected specimen disclosed ischemic intestinal lesions caused by marked phlebosclerosis.

　As ischemic intestinal lesion caused by a venous factor has been rarely reported, we discuss the clinical and histological characteristics of this case.