大腸のsegmental hypoganglionosisにより慢性偽性腸閉塞症を来した1例

Chronic Intestinal Pseudo-obstruction Induced by Acquired Segmental Hypoganglionosis of the Colon, Report of a Case

要旨　患者は49歳，男性．9年前に神経Behget病を発症し当医院神経内科に人院．このとき行った大腸X線検査では明らかな異常所見を認めなかった．9か月前より腹部膨満感排便困難が出現し経口摂取が困難となり，近医で治療を受けたが改善しないため当科入院となった．大腸X線検査にてS状結腸から下行結腸に栂指圧痕様の腸管の伸展不良を認め口側の腸管は拡張していた．大腸内視鏡検査で同部位の腸管はspasticで伸展不良を認めたが粘膜面に異常はなかった．他の消化管には明らかな異常は認めず，病変は大腸に限局していると考えられたため大腸亜全摘術を施行した．切除標本の検索にて，S状結腸から下行結腸においてAuerbach神経叢とMeissner神経叢の神経節細胞が著明に減少していた．本例は，後天性に生じた分節状のhypoganglionosisにより慢性偽性腸閉塞症を来したものと考えられた．

　A 49-year-old male was admitted to our hospital because of abdominal distension and disturbed bowel habit in November 1997. He had been diagnosed as having neuro-Behcet's disease in 1988. The radiographic examination of the colon in 1988 revealed no abnormal finding. Abdominal distension and disturbed bowel habit had begun in September 1996 and these symptoms continued regardless of any medical treatments. Barium enema radiography demonstrated a narrow segment in the sigmoid colon and the descending colon along with a dilated colon above the stricture. Endoscopy revealed a spastic and narrow segment with intact mucosa in the descending colon. Subtotal colectomy was performed and the histologic examination of the resected specimen showed remarkable reduction in the number of ganglion cells of Auerbach's and Meissner's plexuses in the narrow segment. He was diagnosd as having chronic intestinal pseudo-obstruction due to acquired segmental hypoganglionosis of the colon.