一過性虚血性大腸炎の1例

Ischemic Colitis

　虚血性大腸炎はMarston¹⁾によると①gangrene of the colon，②ischemic stricture，③transient ischemic colitisに分類されている．一過性の虚血性大腸炎は頻度が高いと思われるが，経過が早いために十分な検査が行われずに診断が不確実となることも少なくない．最近，私たちは発症後早期にX線および内視鏡検査にて診断し，経過を観察した本症の1例を経験したので報告する．

　症　例

　患　者：70歳，女．

　主　訴：腹痛，下血．

　既往歴，家族歴：特記すべきことなし．

　現病歴：1979年12月27日夜間入浴後に突然軽い嘔気，下腹部鈍痛出現，便意を催し，排便時に新鮮な血液の混入を認めた．その後も腹痛が続き，新鮮血のみの排出を2～3回みた．12月28日本院受診，直ちに直腸鏡検査施行．肛門縁より15cmの検索範囲に異常なく，口側より旧血液が流れてくるのが観察され，緊急入院した．

　A case of transient ischemic colitis is reported in which the diagnosis was made within 24 hours of the onset of symptoms with endoscopic and barium enema examination.

　A 70 year-old woman was admitted to Keio University Hospital on 28th December, 1979, complaining of abdominal pain and bloody stool of 12 hours' duration.

　On examination there was no physical sign except localized tenderness in the left lower abdomen. Instant fiberoptic colonoscopy on admission showed edematous mucosa with submucosal hemorrhage and multiple erosions in the distal portion of the descending colon, but appearance of rectal mucosa was normal. Barium enema examination, performed two days later, showed a ragged area with obvious ‘thumb printing' in the descending colon.

　Abdominal pain and bloody stool had gone within five days with intensive conservative treatment.

　Second barium enema performed 15 days later showed marked improvement and revealed only few healing ulcers with converging folds. Following colonoscopic examination revealed mucosal redness and a few small ulcers with converging folds. Selective mesenteric angiography performed 18 days after the onset showed no abnormal findings.

　She was discharged without any complaint and has remained well.

　We emphasize that early diagnosis of ischemic colitis is important in relation to the subsequent management of the patient.