虚血性大腸炎の1例

Ischemic Colitis

　6カ月以上の経過観察で，X線・内視鏡所見で多少の改善はみられたが，完全治癒には至らなかった，虚血性大腸炎を報告する．

　症　例

　患　者：54歳，主婦．

　主　訴：突然の下腹部痛，下血．

　家族歴，既往歴：特記すべきことなし．

　現病歴および経過：1978年11月28日（発症第1日目―以下発症後の日数で記載する）の夜間，突然に下腹部激痛を覚え，多量の排便とともに，新鮮血下血をみた．排便後とう痛は軽減した．その後も，下腹部痛と下血が時折あったため，発症後25日目に当科を受診．注腸X線検査と内視鏡検査で，S状結腸の狭小化と潰瘍がみられ，精査のため入院．

　A 54 year-old female came in to our hospital with a month history of intermittent lower abdominal pain and rectal bleeding. She suddenly started to have above symptoms, which lasted on and off for nearly a month.

　A double contrast barium enema examination was reported as showing tubular narrowing of the proximal sigmoid colon with disappearance of “fine network patterd”. At colonoscopy, the mucosa of the proximal sigmoid colon looked fragile with an area of redness or pathy white exudate. She was diagnosed as having ischemic colitis and gradually subsided with conservative treatment.

　She was once discharged from the hospital and was on follow-up at the outpatient clinic for six months. During the follow-up, her feces was nearly always positive for occult blood. A repeated double contrast barium enema and colonoscopy showed only a little improvement of the pathological findings, and therefore, she was referred to surgical treatment.

　In the resected specimen, there was a girdle ulceration about 9 cm in the longitudinal diameter with island like mucosal elevations. A histological examination showed shallow ulceration of Ul-Ⅰ degree with a focus of regenerative epithelia. Severe inflammatory cell infiltration and fibrosis were seen in the submucosa. This case was thought as a transient type ischemic colitis of Marston's classification.