壊死型虚血性腸炎の臨床像—NOMIを含めて

Clinical Features of Gangrenous Ischemic Colitis and Non-occlusive Mesenteric Ischemia

要旨●壊死型虚血性腸炎および非閉塞性腸間膜虚血（NOMI）は，腸間膜動脈主幹部の器質的閉塞を認めず，腸管血流の需給バランスの不均衡によって引き起こされる致死的な虚血性腸疾患である．NOMIは広義の壊死型虚血性腸炎の範疇に含まれ，腸間膜血管の攣縮を主病態とした疾患である．いずれも疾患特異的な徴候は乏しく，確定診断には各種画像検査を要する．治療の基本は，壊死腸管の切除と敗血症性ショックに対する呼吸循環管理であるが，明らかな腸管壊死を認めないNOMIの発症早期においては保存的加療も治療の選択肢となり得る．

　Gangrenous ischemic colitis and NOMI（non-occlusive mesenteric ischemia）are life-threatening ischemic bowel diseases caused by an imbalance between the supply and demand of intestinal blood flow, without an organic obstruction of the main trunk of the mesenteric artery. NOMI is mainly characterized by vasospasm and is classified into the broad category of gangrenous ischemic colitis. NOMI and gangrenous ischemic colitis lack disease-specific signs and require imaging for a definitive diagnosis. Basic treatment principle for gangrenous ischemic colitis and NOMI is complete resection of necrotic bowel and sepsis and septic shock management ; however, during the early stage of NOMI, conservative treatment may be an option if no evident necrosis is noted.