発症より経過観察しえた虚血性大腸炎の1手術例

A Surgically Treated Ischemic Colitis

　最近の高齢化社会に伴い，わが国でも虚血性腸炎が次第に注目されるようになってきた．著者らは発症の早期から経過観察しえて，しかも典型的な症状と，X線所見を呈した虚血性大腸炎を経験したので報告する．

　症　例

　患　者：67歳，女．

　主　訴：腹痛，下血．

　前病歴：以前から本態性高血圧症があり，内服治療を受けていた．約2年前高血圧症に伴う一過性の意識消失発作があり，脳血管障害として入院治療を受けたことがある．しかし四肢麻痺は残さなかった．

　現病歴：1979年10月11日突然腹部の激痛が発現した．痛みは周期的で，腹がもりもり張ってくるようにして痛み，その度に頻回に便意を催し，最後には便所から出られないような状態となって意識消失して倒れた．そのとき多量の血便を排泄した．

　A 67 years old woman was admitted with an acute abdominal pain and a large amount of fresh blood stool.

　Barium enema was performed 24 hours after onset, and double contrast approach revealed typical thumb printing figures. Bloody stools stopped three days later, and the patient had an asymptomatic interval for two weeks. However, as abdominal distention with increasing constipation occurred, barium enema was performed again at the 25th day after the onset. It revealed a remarkable stenosis with ulcers and pseudodiverticula in the splenic flexure. On 46th day left hemicolectomy was carried out with a preoperative diagnosis of ischemic colitis. A stenosis with edema and hyperemia was remarkable without any abnormality of the mesenterium.

　The specimen revealed longitudinal ulcers with spread branches on the mesenteric side, and almost all had already healed. Regenerated epithelium had microscopically covered the ulcers, and marked fibrosis and several number of Hemosiderin-laden macrophages were recognized in the submucosa and the muscle layers. These findings strongly suggested segmentary ischemic colitis.