多発縦走潰瘍とsacculationを伴った狭窄型虚血性大腸炎の1例

Strictured Form of Ischemic Colitis, Associated with Multiple Longitudinal Ulcers and Sacculations

　約1カ月の経過で急性期から慢性狭窄型へと移行し，多発縦走潰瘍やsacculationを合併した虚血性大腸炎を経験し，潰瘍の局在性について興味ある所見を得たので報告する．

　症　例

　患　者：52歳，男．

　主　訴：腹痛，下血．

　現病歴：20年来軟便傾向で，週1回ぐらい下痢があり，労作時に動悸，息切れを訴えることがあった．1979年3月下旬に感冒様症状があり，3月30日朝食前に排便し，その直後から腹部全体のキリキリする痛みが出現した．痛みは徐々に左下腹部に限局し，15分ぐらいで最強となった．この後血性下痢を4～5回繰り返し，嘔吐も1回認めた．翌日にも同様の発作があり本院受診．注腸造影で下行結腸に異常を指摘され，同年4月19日内科入院となった．

　A 52 year-old male came to Kitasato University Hospital in March 31, 1979, complaining of left lower abdominal pain and bloody diarrhea with vomiting. There was a sausage-like mass with moderate tenderness in the left lower quardrant.

　Laboratory data showed the following: Hb 12.4g/100ml, WBC 9,200, T. P. 7.1g/100ml (α₁-glob. 5.1%), ESR 55mm/hr, and CRP was 6 positive. ECG showed myocardial ischemia.

　Barium enema, performed at the seventh day after onset, revealed loss of haustration and thickening of the folds in the descending colon. Follow up study at four weeks after onset, demonstrated multiple shallow ulcers and sacculations with tubular narrowing. In addition to this findings, skip area was shown in the splenic flexure. On colonoscopic examination, multiple longitudinal ulcers and pseudodiverticula were observed.

　From these findings we diagnosed this case as ulcerated and strictured form of ischemic colitis. He was treated palliatively, but stenotic symptom remained unchanged. So laparotomy and left hemicolectomy was performed on May 30, 1979.

　The resected specimen showed long segmental narrowing with thickening of the intestinal wall and color change. There were multiple healed longitudinal ulcers on the mesenteric aspect or the tenia coli.

　Histologically, fibrosis and proliferation of the granulation tissues with deposit of iron pigments from the mucosa to the muscularis propria were observed.