食道静脈瘤様の所見を呈した終末回腸動静脈奇形の1例

Arteriovenous Malformation of the Terminal Ileum with the Appearance of Esophageal Varices, Report of a Case

要旨　特異な形態を示した回腸動静脈奇形の1例を報告した．患者は54歳，女性．1997年，高度貧血の原因精査目的で当院に入院した．小腸X線検査では，終末回腸に約15cmにわたり縦長で軟らかい連珠状の隆起性病変を認めた．大腸内視鏡検査では隆起は正常粘膜に覆われ，やや青みがかった軟らかな病変で，血管性病変と診断した．上腸間膜動脈の血管造影では，回結腸動脈の拡張と，回腸末端を中心にnidusと思われる血管叢を認め，静脈相では早期静脈環流が出現していることより，上腸間膜動脈と上腸問膜静脈の動静脈奇形と診断した．高度の貧血を繰り返していたので，回盲部切除術施行．切除標本の病理組織学的検索にて，動静脈奇形と確診した．

　In this case report, we present a peculiar case of ileum arteriovenous malformation. The patient was 54-year-old woman. She was admitted for the investigation of the cause of severe anemia, in 1997. In x-ray examination, the shape of the soft lesion at the terminal ileum was moniliform, 15 cm in length, and it was longer than it was broad. In total colonoscopy, the torose lesion was coated with normal mucosa, it was soft and its color was blue. These endoscopic findings in the large intestine suggested that the lesion at the terminal ileum might be a vascular lesion. In superior mesenteric artery angiography, the ileocolic artery was seen to be enlarged, and a vascular tuft thought to be the nidus was founded in the terminal ileum. In the venous phase of angiography, early venous appearance was recognized. Therefore, we clinically diagnosed the lesion as arteriovenous malformation of the superior mesenteric artery and superior mesenteric vein. Excision of the lesion at the ileocecum was performed because the seriously anemic condition of the patient was thought to be caused by the lesion. The clinical diagnosis as arteriovenous malformation was confirmed by the pathological findings of the excised lesion.