下腸間膜静脈閉塞による虚血性大腸炎の1例

Ischemic Colitis Caused by Inferior Mesenteric Venous Occlusion, Report of a Case

要旨●患者は76歳，男性．腹部膨満感，食欲不振を主訴に前医を受診した．高度の炎症反応を伴う左側結腸の腸管壁肥厚から腸間膜脂肪織炎が疑われた．プレドニゾロン全身投与を含む保存的治療で症状はいったん改善したが，4か月後に再燃を来したため当科へ紹介され，受診となった．大腸内視鏡検査では，腸管浮腫に加えて縦走・帯状潰瘍を認めた．さらに血管造影検査では下腸間膜静脈が描出されず，下腸間膜静脈閉塞の所見と考えられた．発症から6か月後には大腸狭窄へと進行したため，外科的切除を行った．病理組織学的に粘膜下層の浮腫と血管増生・蛇行を認めるものの血管炎の所見はなかった．以上より，下腸間膜静脈閉塞に起因した虚血性大腸炎と考えられた．

　A 76-year-old male was admitted to a referring hospital with worsening symptoms of abdominal distension and appetite loss. Mesenteric panniculitis was suspected because of the evidence of severe inflammatory reaction syndrome and the thickening of the colonic wall and omentum. Although symptoms were transiently improved by medication, abdominal symptoms recurred after 4 months. Repeated colonoscopy revealed longitudinal and extensive ulceration throughout the descending colon. Occlusion of the inferior mesenteric vein was revealed using angiography. Surgery was subsequently performed to relieve colonic stenosis. Histological findings demonstrated edema and vascular proliferation within the submucosal layer. Occlusion of mesenteric vein by various types of thrombin and scattered panniculitis in the omentum were also observed. A diagnosis of ischemic colitis was made following the demonstration of occlusion of the inferior mesenteric vein.