Lupus vasculitisによる麻痺性イレウスの1治験例

A Case of Paralytic Ileus Due to Lupus Vasculitis

　Klemperer¹⁾によって膠原病という概念が提唱されて以来，全身性エリテマトーデス（Systemic Lupus Erythematosus）は，その代表的疾患の1つとされてきた．

　周知のごとく，全身性エリテマトーデス（以下S. L. E.）は，顔面の鼻と頬を中心とした蝶形紅斑を特徴とするが，皮膚のみならず，全身の諸臓器をも侵し，緩解と増悪を繰り返しながら，漸次進行する難治性疾患である．

　It is generally recognized that the gastrointestinal manifestations associated with systemic lupus erythematosus (SLE) are transient and reversible in most cases. So many of these cases are often misdiagnosed as nonspecific gastroenteritis, unless strict attention is paid to the roentgen findings. We report here a case of paralytic ileus as one of the gastrointestinal manifestations of SLE.

　A patient, 17-year-old boy, had been ill with SLE since July 1973, when facial butterfly rush and fever appeared. Since then the treatment with hydrocortison was started.

　On February 23, 1977, fever and epigastralgia appeared suddenly. A plain film of the abdomen revealed the localized gas-filled jejunal loops in the upper abdomen. But his first abdominal symptoms disappeared soon after administration of an increased dose of steroids.

　On September 6, 1977, he again complained of abdominal pain, nausea and vomiting, so he was admitted to our department on suspicion of the acute surgical condition of the abdomen. At this time, abdominal plain film also showed the distended jejunal loops in the upper abdomen, which suggested a mild degree of paralytic ileus. Gastrointestinal X-ray series revealed dilatation and lack of tone in the second and third portions of the duodenum with retardation of barium passage through the duodenum. A superior mesenteric arteriogram showed irregularity and narrowing of the artery feeding the gas-stagnated jejunal loops.

　From these roentgenological findings, it is presumed that paralytic ileus must have been caused by lupus vasculitis in the mesenteric artery. Then he was treated with large doses of hydrocortison, and he was free from abdominal problems up to this time.