虚血性大腸炎の1例

Ischemic Colitis, Report of a Case

　虚血性大腸炎は比較的高齢者に多いとされている．今回われわれは血液透析中の20歳の女性患者に発生した虚血性大腸炎の1例を経験したので報告する．

症例

　患　者：20歳，女性．

　主　訴：下血．

　家族歴：特記すべきことなし．

　既往歴：1976年蛋白尿を指摘されたが，そのまま放置していたところ1978年4月になり全身倦怠および意識障害の出現をみたので東北大学第2内科に入院し，慢性腎不全と診断され腹膜灌流，次いで血液透析を受けるに至った．

　現病歴：その後引き続き某腎クリニックにおいて定期透析を受けていたが，1980年9月20日より上腹部痛があり，鎮痙剤を服用していた．9月22日，いつものように定期透析を受け帰宅したところ，上腹部痛が増強し同時に2度の排便をみたが，2度目の便は暗赤色調であったので某病院に入院した．

　The patient, a woman 20 years of age, was undergoing periodically hemodialysis because of chronic renal failure. She was admitted to the hospital as she had two-day-long upper abdominal pain succeeded by melena after the pain became worse. Barium enema x-ray examination on the following day showed circumferential narrowing and ulceration about 9 cm long in the transverse colon near the hepatic flexure. As we were usable to rule out malignancy, she underwent an operation on the 10th hospital day. Histologically the lesion showed in the submucosal layer circular ulceration, inflammatory cellular infiltration on the ulcer base together with hemosiderin-laden macrophages. Marked edema was seen in the adjacent non-ulcerative mucosa. Clinical course, findings of barium enema x-ray examination as well as histologic changes suggested that this disease be ischemic colitis due to some circulatory disturbance. Although the patient needed periodical hemodialysis, no changes were recognized in the vascular system around the lesion. Nonetheless, we have come across a patient with ischemic colitis developing in the course of hemodialysis and we believe this disease is one of the complications of hemodialysis in patients with renal failure.

　As far as we were able to ascertain, the present patient was the youngest among those with ischemic colitis.