小腸動静脈奇形の1例

Arteriovenous Malformation of the Small Intestine, Report of a Case

要旨　患者は54歳，男性．糖尿病，肝機能障害で外来通院中，1987年7月下旬，黒色便と高度の貧血のため入院．消化管透視，内視鏡では出血源は明らかでなかったが，貧血の進行を認めず9月19日退院．10月下旬，再び黒色便となり11月2日再入院．入院時，赤血球146×10⁴/mm³，血色素4.5g/dlヘマトクリット14.0％．第3病日，腹部血管造影を施行．上腸間膜動脈空腸枝末梢に異常血管の集簇，早期静脈還流を認め，小腸動静脈奇形と診断．小腸部分切除術を施行，以後貧血の進行は認めない．通常の消化管透視，内視鏡によって出血源不明な消化管出血の症例には血管造影も有用と思われ報告した．

　A 54-year-old man was hospitalized for the first time because of melena and anemia in July, 1987. Upper gastrointestinal series, small intestinal x-ray examination, barium enema, and colonoscopy revealed no obvious source of bleeding.

　On November 2, 1987 the patient presented with his second episode of massive bleeding. Superior mesenteric arteriography revealed the presence of abnormal vessels and an early draining vein leading to the diagnosis of arteriovenous malformation (AVM) (Fig. 2). A part of the small intestine, about 12 cm in length, was resected. The presence of AVM was confirmed by pathological examination (Fig. 6).

　Postoperative course was uneventful with the improvement of anemia and he has experienced no further episode of melena since then.