高齢者の全結腸型憩室症の1例

Multiple and Pan-colonic Type of Diverticular Disease in the Aged Person Which Was Complicated with Hemorrhage

　結腸憩室症のうち右側結腸にみられるものは，加齢と共に増加し二次的に発生してくるものであると考えられている．ここでは，高齢，多発性全結腸型憩室症で，出血を合併した症例を提示する．

　症　例

　患　者：本○あ○，82歳（1975年），女．

　家族歴：特別のことはない．

　既往歴：高血圧（186/84），心電図上完全右脚ブロック．

　現病歴：1970年頃より左下腹部に疹痛が出没していた．1975年3月29日より，特別の誘因なく左下腹部痛を伴う下血が始まった．軽度発熱．嘔気・嘔吐なし．以前より便秘傾向があったが，下血が始まってからは出血のため失禁状態となって3月31日入院した．出血量は判明しないが，受診時は肛門から鮮血が常時小量ずつ排出されていた．

　The patient was 82 year-old female who was known to have hypertension and hypertensive cardiovascular disease and had been receiving diuretics and digitalis. She was married, G-3, and had been obese all her life. She had tendency of constipation and began to have intermittent left lower abdominal pain in 1970. On March 29, 1975, she developed left lower quadrant abdominal pain with hemorrhage and low grade fever without any cause. She was hospitalized on March 31 and her blood pressure on admission was 130/70 mmHg but had severe anemia (RBC 298×10⁴, Hgb 9.6 g/dl,Hct 28%) and tachycardia. U. G. I. series showed no bleeding site but L. G. I. series disclosed multiple diverticulae from the hepatic flexure to sigmoid colon. Colonoscopy showed diverticula beyond the 20 cm from the anus but failed to confirm the bleeding site. Blood transfusion was performed for 7 days (total 1,000 ml) and elective surgery was performed. Considering the patient's old age and risk of the operation, left-sided hemicolectomy was performed and only purse-suture was done for the residual diverticulae in the right side hemicolon.

　The patient has been followed post-operatively for 5 years but no complications such as re-bleeding diverticulitis and perforation have occurred.