腹腔鏡補助下大腸切除術を施行した特発性腸間膜静脈硬化症の1例

A patient with idiopathic mesenteric phlebosclerosis treated with laparoscopy-assisted colectomy

◆要旨：患者は73歳，女性．腹痛，腹満感を主訴に前医を受診した．麻痺性イレウス疑いにて当院消化器内科を紹介され受診した．特発性腸間膜静脈硬化症（IMP）による繰り返すイレウスと診断され，手術適応と判断された．既往症として糖尿病，高血圧があり，種々の漢方薬の長期服用歴があった．内視鏡・注腸検査と生検病理検査において病変範囲に乖離が認められ，最終的に病理検査結果をもとに切除範囲を決定した．腹腔鏡補助下大腸亜全摘術を施行し，良好な経過を得た．既報告の検索範囲内で，IMPに対して病変範囲決定に病理生検を用い，治療に腹腔鏡補助下大腸亜全摘術を行った報告例はなかった．

A 73-year-old female visited her family doctor complaining of abdominal pain and discomfort. Diagnosis of paralytic ileus was made. She was referred to the department of gastroenterology in Jichi Medical University Hospital for further examination and was diagnosed as idiopathic mesenteric phlebosclerosis （IMP）. She had a long history of taking Chinese herb medicines for hypertension and diabetes administered by her family doctor. Endoscopic findings showed the range of the disease extending to the left transverse colon, however, pathological findings of the biopsied specimens suggested the range of the disease extending up to the descending colon. Laparoscopy-assisted subtotal colectomy （from cecum to descending colon） was performed and pathological diagnosis of the resected margin was free of disease. Postoperative course was uneventful. This will be the first report of an IMP patient treated with laparoscopy-assisted colectomy.