S状結腸瘻を合併した虚血性小腸炎の1例

Ischemic Enteritis Complicated by Ileocolonic Fistula, Report of a Case

要旨　患者は60歳代の女性．2011年8月に，向精神薬が原因と考えられる悪性症候群による多臓器不全にて当院ICUへ入院した．入院経過中に多量の血便を認め，輸血を必要とした．2011年12月頃より，腹痛，水様性下痢が持続し，2012年6月に内視鏡検査を施行した．回腸遠位部に狭窄を伴う全周性の潰瘍を認めた．X線造影検査では，同部位に約6cm長にわたる管状狭窄，回腸S状結腸瘻を認め，臨床経過と併せて回腸結腸瘻を合併した虚血性小腸炎と診断した．2012年7月に小腸部分切除，瘻孔閉鎖術を施行した．病理組織学的には，Ul-IVの組織欠損を有する虚血性小腸炎と診断した．

　A woman in her sixties who had been receiving antidepressant treatment for depression was admitted to the ICU with multiple organ failure due to malignant syndrome in August 2011.

　Due to a large quantity of blood in her stool during hospitalization, the patient needed a blood transfusion. She complained of abdominal pain and watery diarrhea starting in December 2011. We thus performed colonoscopy in June 2012.

　Colonoscopy revealed a circumferential ulcer in the ileum with severe stricture.

　X-ray examination revealed severe stricture in the ileum, 6cm in diameter, and demonstrated an ileosigmoid fistula.

　These findings suggested ischemic enteritis with stricture and an ileocolonic fistula. The patient thus underwent partial resection of the ileum and fistula closure was achieved in July 2012. Pathological findings were compatible with ischemic enteritis associated with Ul-IV scar.