虚血性小腸炎の1例

Ischemic Enteritis, Report of a Case

　最近，われわれは高齢者の虚血性小腸炎と思われる1例を経験したので報告する．

　The patient was a 73-year-old woman who was admitted with upper abdominal colicky pain. Ultrasound study and upper gastrointestinal endoscopy were performed and a diagnosis of cholelithiasis was made. However, on the next day she developed tenderness and muscular defence at the left side of the abdomen. Small bowel follow-through was performed after stabilizing her general condition and it showed tubular small bowel narrowing, thumb-printing, “sawtooth” irregularity and longitudinal ulcer at the same part of the muscular defence. Superior mesenteric arteriography failed to show any abnormalities.

　Therefore, she was diagnosed to have ischemic enteritis and cholelithiasis preoperatively, then underwent laparotomy on the 20th day from the onset of her symptoms. The laparotomy disclosed perforation and adhesion at 50 cm proximal to ileocecal region, and the lesion was resected with 23 cm of adjacent ileum and cholecystectomy was also performed.

　The resected small intestine showed circumferential and flecked ulcerations for 10 cm long, and partly perforated. Histological evaluation showed no specific granuloma such as tuberculosis and Crohn's disease, and a diagnosis of nonspecific small bowel ulcer was made. Past medical history showed no signs of Behçet's syndrome and Congo-red stain was negative which was against for amyloidosis.

　From the above clinical course, laboratory data and histological findings, the patient was diagnosed to have ischemic enteritis. Gallstone attack and increased intraluminal pressure by air inflation at upper gastrointestinal endoscopy could be one of the triggers of developing ischemic enteritis.