成人の大腸segmental hypoganglionosisの1例

Segmental Hypoganglionosis of the Colon in an Adult, Report of a Case

要旨　患者は30歳代，男性．2007年1月下旬から便秘となり，腹痛が出現したため当院外来を受診した．腹部X線検査などにより腸閉塞と診断され，緊急入院した．大腸内視鏡検査所見にて下行結腸に潰瘍性病変を認めた．大腸X線検査所見では，下行結腸からS状結腸移行部に母趾圧痕像を思わせる所見や攣縮様の所見が存在し，同部は狭小化していると思われた．また，送気により伸展することから器質的な狭窄ではないと考えた．入院後，腸閉塞が改善しなかったため，約20cmにわたる狭小部の大腸部分切除を施行した．同部の病理組織学的所見において，大腸の神経叢は全体的に萎縮し，神経節細胞数も著明に減少していた．以上から，segmental hypoganglionosisと診断した．

　A patient in his 30's was admitted to our hospital because of stomachache after a few days of constipation in January, 2007. He had been diagnosed as ileus by abdominal X-ray examination and hospitalized urgently. Endoscopy revealed an ulcerous lesion in the descending colon. Barium enema radiography demonstrated a thumb-printing lesion and a spastic lesion at the junction from the descending colon to the sigmoid colon, seeming by to the permanent narrow segment. Subtotal colectomy of about 20cm was performed on the narrow segment and the histologic examination of the resected specimen showed the atrophic change of the intraluminal nerve plexuses generally and remarkable reduction in the number of ganglion cells in the narrow segment. He was diagnosed as having segmental hypoganglionosis of the colon.