特発性腸間膜静脈硬化症の臨床―内視鏡診断

Clinical and Endoscopic Features in Patients with Idiopathic Mesenteric Phlebosclerosis

要旨　特発性腸間膜静脈硬化症は，病変部腸管の静脈に石灰化を来し，慢性虚血性の病状経過をとるまれな疾患である．病変は盲腸や上行結腸を主とした右側結腸に好発し，直腸やS状結腸にはまれである．大腸内視鏡所見では，粘膜面は暗紫色や暗黒色などの特徴的な色調を呈し，腸管浮腫によりhaustraの腫大や不明瞭化を認める．さらにびらんや潰瘍を合併したり，腸管の変形や狭小化を伴う場合がある．腸閉塞症状を繰り返し，X線所見で腸管壁に沿った石灰化を認める症例では本症を疑い，積極的に大腸内視鏡検査を行うことが診断に重要である．

　Idiopathic mesenteric phlebosclerosis is a rare disease characterized by calcification of veins in the affected region of the intestine, associated with chronic ischemia. Lesions most often develop in the right side of the colon and mainly involve the cecum and ascending colon. Lesions are rarely found in the rectum or sigmoid colon. On colonoscopic examination, the surface of the mucosa is characteristically dark purple or pitch black. The haustra of the colon are enlarged or obscured by intestinal edema. Erosions, ulcers, and deformity or narrowing of the intestine may also be present. Idiopathic mesenteric phlebosclerosis should be suspected in patients with repeated symptoms of intestinal obstruction and radiographic evidence of calcification along the intestinal wall. Colonoscopic examination should be actively performed to establish a diagnosis in such patients.