空腸に限局性虚血を来し保存的に治療した上腸間膜静脈・門脈血栓症の1例

Superior Mesenteric and Portal Vein Thrombosis with Localized Ischemic Lesion in the Upper Jejunum Treated without Surgical Intervention, Report of a Case

要旨　患者は49歳，男性．2011年7月下旬より腹部膨満感を自覚し，数日後に左下腹部痛，嘔吐が出現した．腹部造影CT検査で上腸間膜静脈・門脈に血栓があり，近位空腸に壁肥厚を認めた．上腸間膜動脈からの血管造影検査では，動脈相で第一空腸動脈末梢の直動脈の描出不良があり，静脈相で上腸間膜静脈本幹の描出不良を認めた．上腸間膜静脈・門脈血栓症に伴う空腸の限局性虚血と診断し，血栓溶解療法を開始した後に血栓は縮小し，症状は改善した．小腸内視鏡検査では，近位空腸に約10cmの限局した黒色調の壊死性粘膜を認めた．ワーファリン^®Rの内服後血栓は再発しなかったが，壊死性粘膜がみられた部位で狭窄が出現した．バルーン拡張術を行い，保存的に経過をみることができた．

　A 49-year-old man complained with abdominal distension in late July 2011. A few days later, he experienced left lower abdominal pain and vomiting. Abdominal contrast computed to be tomography（CT）revealed thrombosis of his superior mesenteric and portal veins, and the thickening of the upper jejunal wall. Trans-superior mesenteric artery portography showed poor contrast of the tip of first jejunal artery in the arterial phase, and poor contrast of the superior mesenteric vein in the venous phase. We diagnosed a localized ischemic lesion in the upper jejunum associated with the superior mesenteric and portal vein thrombosis. After initiation of thrombolytic therapy, the thrombus decreased in size and the symptoms improved. Enteroscopy revealed necrotic mucosa in approximately 10cm in the upper jejunum. Warfarin was administered for thromboprophylaxis and the thrombosis, and these did not recur. However, the segment of the upper jejunum with necrotic mucosa developed stenosis. We were able to conservatively treat the lesion by balloon expansion.