経過観察しえた腸管囊腫様気腫の1例

Pneumatosis Cystoides Intestinalis, Report of a Case: A follow-up study until its complete

　腸管囊腫様気腫は，主に小腸または結腸の漿膜下および粘膜下に多発性の含気性囊胞を形成する比較的稀な疾患で，現在までにわが国では約200例近い報告例があり，全世界では1,000例以上の報告例がある¹⁾．

　最近，S状結腸に限局し他に消化管疾患を伴わないprimary typeの本症で，経過観察中，囊腫が消失した症例を経験したので報告し，若干の文献的考察を加える．

　Pneumatosis Cystoides Intestinalis (PCI) is a relatively rare disease and most of them are discovered at the time of surgical operation or autopsy. We have experienced a case of primary type PCI restricted to the sigmoid colon without accompanying original disease, in which the cystoma disappeared during observation of the course. The patient was a 45 year-old man. He underwent the operation for congenital atrial septal defect when he was 35 years old. He was suffering from black stool, constipation and unpleasant feeling in the upper abdomen, which became worse gradually in 1977. He was examined by a certain doctor and was diagnosed to have colonic polyposis and the patient visited us for the purpose of operation. No abnormal finding was found by general hematological examination at the time of hospitalization. Chest x-ray examination showed intesified shadow of pulmonary blood vessels considered due to ASD. By abdominal x-ray examination, small and large gas foams like a honey-comb shadow were observed from the pelvic cavity to middle abdomen. Barium enema revealed many broad-based tumors with smooth surface all over the sigmoid colon and the size of them was from a red bean to the head of thumb. Endoscopic examination of the colon showed diffuse lesions with protrusion like a hemisphere which were large and small and with smooth surface covering all over sigmoid colon. The part of protrusion was covered with normal mucous membrane.

　We diagnosed the lesions as a primary type PCI from the above findings and gave only symptomatic treatment and observed the course endoscopic-ally. After six months, the protruded lesions were reduced in size and after one year, they disappeared completely.

　Prognosis of primary type PCI is favorable and spontaneous disappearance is observed at a fairly high frequency and in our case also it vanished spontaneously by symptomatic treatment.

　Indication of operation should be made very carefully. Our case is important with respect to the fact that we were able to observe the course endoscopically until complete disappearance.