酸素療法が著効を示したpneumatosis coliの1例

Pneumatosis Coli with Oxygen Treatment, Report of a Case

要旨　喘息の既往を持ち肺結核にて入院した60歳男性．右側腹部痛，下痢のため腹部X線，注腸造影，大腸内視鏡検査を行い，上行結腸に空気囊胞を認めたので，鼻孔カニューレを用いて酸素療法を行い軽快した症例を報告した．酸素療法は空気囊胞には非常に有効な方法で，1973年のForgacsの報告以来，酸素テント，マスク，高圧酸素療法など種々の方法が用いられてきたが，PaO₂が200～300mmHgに維持できるような方法で少なくとも7日問投与されれば，どのような方法によっても空気囊胞は消失するものと老えられた．しかし酸素療法によっても26％に再発がみられるので長期経過観察が必要である．

　A 60 year-old man who had a history of bronchial asthma was admitted to our hospital with pulmonay tuberculosis in January 1981. Examination of abdominal x-ray, barium enema and colonofiberscope was done in March 1982 because of his abdominal pain and diarrhea. These examinations revealed multiple polypoid lesions with gas-filled cysts in the ascending colon, so we started to treat this patient with oxygen using nasal cannula (5l/min-5hrs/day×7 days＋5l/min-1hr/day×3weeks). His complaints and findings of abdominal x-ray and barium enema improved after seven days with oxygen treatment. Recurrence was not seen in any colonic region after eighteen months.

　Oxygen treatment is the most effective method for pneumatosis coli. Forgacs reported the oxygen therapy for pneumatosis coli first in 1973. Since his report, various methods (such as hyperbaric oxygen, oxygen tent, oxygen mask, nasal cannula, etc) were used, but we would like to conclude that any oxygen method is usefull for pneumatosis coli, if we will be able to treat the patients with following mode : arterial blood PaO₂ should be kept at the level of 200-300 mmHg, and the oxygen should be given for at least seven days. We consider that colonic gas-cysts would disappear if adequate concentration of oxygen is given over a sufficient period of time. No significant side effects were seen. But recurrence ratio after oxygen treatment was 26%, so we must follow these patients with pneumatosis coli for a long time, and if it would recur, oxygen therapy should be re-started.