特異な形態を呈した空腸動静脈奇形の1例

Jejunal Arteriovenous Malformation with Special Morphology, Report of a Case

要旨●患者は60歳代，男性．小腸出血疑いで当院に転院となった．経口的ダブルバルーン小腸内視鏡検査では，空腸に亜有茎性の隆起性病変を認め，隆起の表面は平滑で，白苔を有し，基部には強い発赤を認めた．白苔を有しており，形態学的にはpyogenic granulomaに類似していたが，拍動を認めること，基部に強発赤を認めることより，動静脈奇形（AVM）を含めた血管性病変を否定できなかった．腹部血管造影検査では，比較的早期の静脈還流を認めた．以上より，AVMと診断し，空腸部分切除術を施行した．切除標本の病理組織所見では，粘膜下層に動静脈の異常な吻合を認め，AVMの所見であった．今回筆者らは，特異な形態を呈した空腸AVMの1例を経験したので報告する．

　The patient was a man in his 60s who was transferred to our hospital with suspicion of small bowel bleeding. Oral double-balloon small intestine endoscopy revealed a pedunculated protruding lesion in the jejunum. The surface of the protrusion was flat ; it had white coat and strong reddening at the base. The white coat were morphologically similar to pyogenic granuloma. However, because pulsation and strong reddening were observed at the base, we could not deny vascular lesions including AVM（arteriovenous malformation）. Abdominal angiography showed comparatively early venous return. Given the above findings, the patient was diagnosed with AVM, and partial resection of the jejunum was performed. The pathological findings of the resected specimen showed abnormal anastomosis of the arteriovenous fistula in the submucosal layer, confirming the diagnosis of AVM. Herein, we report an unusual case of jejunal AVM with special morphology.