23.消化管の血管性病変angiodysplasia，AVM，Rendu-Osler-Weber病，血管腫，Dieulafoy潰瘍

Vascular Diseases of the Gastrointestinal Tract―Angiodysplasia, Arteriovenous Malformation, Cavernous Hemangioma, Hereditary Hemorrhagic Telangiectasia, Dieulafoy's Lesion

要旨　消化管の血管性病変は，血管拡張から悪性腫瘍まで多くの疾患が含まれる．自験例を提示しangiodysplasia（AGD），arterovenous malformation（AVM），hereditary hemorrhagic telangiectasia（Rendu-Osler-Weber病），血管腫，Dieulafoy潰瘍，について述べた．AGDは，72歳男性の上行結腸でみられ，アルゴンプラズマ凝固（APC）治療を行った症例である．AVMは，小腸に広範に拡がり術前出血部位の同定が困難であった59歳男性の症例を提示した．Rendu-Osler-Weber病は，83歳の高齢者で高度の貧血があり，繰り返す鼻出血，粘膜の毛細血管拡張を認め，胃AGDに対しAPCを行った症例である．血管腫は，61歳男性の下行結腸にみられた海綿状血管腫手術例である．Dieulafoy潰瘍は，36歳男性で，胃穹窿部の病変で止血に難渋した手術症例である．

　Vascular diseases of the gastrointestinal tract are important in the management of gastrointestinal bleeding. We described five cases of gastrointestinal vascular diseases which include angiodysplasia, arteirovenous malformation, cavernous hemangioma, hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease) and Dieulafoy's lesion. Angiodysplasia presents irregulary shaped clusters of ectatic small arteries, small veins and their capillary connections. These lesions are called by various names such as vascular ectasia or angiectasia. We encounted a case of a 72-year-old male with colonic angiodysplasia treated by argon plasma coagulation (APC). A case of arteriovenous malformation of the ileum in a 59-year-old male was also reported. Submucosal dilated abnormal vessels were observed in the patient. We also encountered a Rendu-Osler-Weber disease case. The patient was an 83-year-old female who was referred to our hospital with severe anemia. Multiple angiodysplasia was noted in her stomach and treated by APC. She had a past and family history of nasal bleeding. Mucosal telangiectases on lips and tongue were also observed. A case of cavernous hemangioma of the descending colon was presented by a 61-year-old male who had no history of bleeding. By endoscopy he was diagnosed as having cavernous hemangioma and the lesion was resected surgically. There was also a case of Dieulafoy's lesion in a 36-years-old male who was referred to our hospital because of massive hematoemesis. Emergent endoscopy revealed Dieulafoy's lesion in the fornix. Endoscopical HSE injection with Spongel was administered to the lesion and temporal hematostasis was tried, but surgical resection was finally selected. Ruptured vessel was observed in the shallow ulceration.