idiopathic myointimal hyperplasia of mesenteric veinsの1例

Idiopathic Myointimal Hyperplasia of Mesenteric Veins, Report of a Case

要旨●患者は60歳代，男性．腹部膨満感と粘液便を主訴に前医を受診し，腸間膜脂肪織炎の診断でステロイド治療を受けるも改善なく経過したため，6か月後に当科へ紹介され受診となった．注腸X線造影検査では下行結腸からS状結腸にかけて長い管状狭窄と拡張不良がみられ，遠位大腸に拇指圧痕像を伴っていた．下部消化管内視鏡検査では下行結腸からS状結腸を中心に全周性区域性の潰瘍と内腔の狭小化を認めた．以上の画像所見と緩徐な臨床経過から，静脈性の虚血性腸病変を考え，腹腔鏡補助下Hartmann手術および横行結腸人工肛門造設術を行った．切除標本の病理組織学的所見では，上皮欠損部に一致する粘膜下層および漿膜下の静脈壁に著明な肥厚と内腔の閉塞がみられたことから，IMHMV（idiopathic myointimal hyperplasia of mesenteric veins）と診断した．

　A man in his seventies went to a nearby hospital complaining of abdominal fullness and mucous stool. Prednisolone was used to treat him after he was diagnosed with mesenteric panniculitis. However, his symptoms did not improve, and he was referred to our facility six months later. A barium enema revealed extensive tubular narrowing and rigidity in the descending and sigmoid colons, as well as thumbprinting in the rectosigmoid colon. Colonoscopy revealed sigmoid and descending colon stenosis, as well as circumferential and segmental ulcers. The patient underwent laparoscopic- assisted Hartmann's operation and transverse colostomy after being diagnosed with ischemic colitis caused by venous occlusion. Histological examination revealed significant thickening of the venous wall of the submucosa and subserosa in the affected segment, indicating idiopathic neointimal hyperplasia of the mesenteric veins.