急性腹症で発症したcollagenous colitisの1例

Collagenous Colitis with Acute Abdomenal Pain, Report of a Case

要旨　患者は62歳，女性．胃食道逆流症のためランソプラゾールを内服していた．突然の左下腹部痛，水様下痢と血便がみられたため受診した．腹部造影CTで横行結腸に粘膜下層を主体とした浮腫による著しい壁肥厚と深い裂創を認め，少量のガス像が腸間膜内にもみられた．内視鏡検査では中部横行結腸から脾彎曲部にかけて一条の深い縦走潰瘍が認められた．保存的治療で改善したが，11日後に同様の症状で受診した．2回目の内視鏡検査では横行結腸の縦走潰瘍は治癒していたが，S状結腸に新たな縦走潰瘍が認められ，生検の結果collagenous colitisと診断された．急性腹症を契機に診断されたcollagenous colitisは極めてまれである．

　A 62 year-old woman, who had been taking lansoprazole for the treatment of gastro-esophageal reflux disease, was admitted to our hospital with the sudden onset of left lower abdominal pain, followed by watery diarrhea and bloody stool. An abdominal CT showed a highly edematous mucosa at the left side of the transverse colon, and the air in the neighboring mesentery suggestive of a mucosal laceration. Colonoscopy revealed the single streak of a long and deep longitudinal ulcer from the middle of the transverse colon to the splenic flexure. Her symptoms improved with conservative treatment. However, the symptoms recurred 11 days after discharge. A second colonoscopy revealed scarring from the longitudinal ulcer at the transverse colon, and a newly-emerged longitudinal ulcer at the sigmoid colon. Colonic biopsies showed thickening of the subepithelial collagen bands. Cases of collagenous colitis with acute abdomen are rare in the literature.