一過性虚血性大腸炎の1例

Transient Ischemic Colitis

　患　者：I. T．81歳，男．

　家族歴：特にない．

　既往歴：70歳で虫垂炎およびそけいヘルニアの手術を受けている．患者は軽度老人性痴呆および屎尿失禁があるため，特別養護老人ホームに入園中であり，1978年2月，ベッドより落ち右大腿骨頸部骨折で入院，観血的手術を受け，3月8日に退院している．

　現病歴：退院後経過は順調であったが，同年6月4日より，特別の原因なく突然大量の下血があった．初診時に行った大腸ファイバースコープおよび注腸X線検査の結果，S状結腸の変化が著しく（Fig.1），少量の下血もあり，食欲不振も伴ったので6月9日当院に入院した．

　A 81 year-old man was admitted to the Sendai City Medical Center because of bloody stool with sudden onset. On physical examination, the blood pressure was 170/102 mmHg. Laboratory studies showed a erythrocyte sedimentation rate of 30 mm in 1 hr, and 58 mm in 2 hr. RBC was 334 mil., Hb 11.4 g/dl, WBC 6,000 and differential was almost normal. Total protein was 4.7 g/dl and albumin 55.3%. Serum K was 2.5 mEq/l. The liver function tests were normal. The chest x-ray film and EKG were normal. Barium enema, showed characteristic thumb printing and narrowing in the sigmoid colon. The fibercolonoscopic examination showed multiple irregular ulcers, and the surrounding mucosa with redness and swelling. Biopsy specimens from the lesion showed inflammatory changes. Symptomatic treatment for diagnosis of ischemic colitis ameliorated hematochezia rapidly. Several ulcer scars and slight deformity were seen by barium enema on the 23rd hospital day. Endoscopic examination also showed several ulcer scars.