虚血性小腸炎の臨床像

Clinical Features of Ischemic Enteritis

要旨　虚血性小腸炎24例の臨床像および検査所見を検討した．病変が回腸に限局する症例は，回腸以外にも病変を有する症例よりも高齢であり，高率に高度狭窄に至っていた．また，続発性の症例は，特発性の症例よりも高度狭窄に至る症例が多かった．小腸X線検査所見では，狭小化・管状狭窄が最も高率にみられ，経過とともに狭窄の程度が高度となっていた．術前の内視鏡検査による病変の観察は9例（37.5％）で可能であり，全周性区域性潰瘍が特徴的であった．15例（62.5％）で外科的切除を要したが，高度狭窄の1例では内視鏡的バルーン拡張術を行い，保存的に加療可能であった．

　We retrospectively analyzed clinical features of 24 patients with ischemic enteritis. Cases of lesions restricted to the ileum were olderly patients and tended to have severe stenosis when compared to those of more extended lesions. Severe stenosis was more frequently observed in cases of secondary ischemic enteritis caused by major vessel occlusion or blunt abdominal trauma than in those of idiopathic ones. Tubular narrowing was the most frequently observed radiographic finding. A review of serial radiographic examinations revealed that severe stenosis progresses over time in most cases. We were able to confirm enteroscopic findings in nine cases prior to resection, among which segmental circumferential ulceration was the most characteristic finding. Although surgical resection was necessary in 15cases, a case with severe ileal stenosis was successfully treated by endoscopic balloon dilation.