経過観察しえた結節性動脈周囲炎による虚血性大腸炎の1例

Periarteritis Nodosa Causing Ischemic Colitis, Report of a Case

要旨　結節性動脈周囲炎（PN）による虚血性大腸炎の1例を経験した．患者は39歳，男性で，腹痛，下血にて入院した．注腸造影で脾彎曲部を中心に横行結腸および下行結腸の一部にthumb-printing様の壁不整や狭窄を認め，大腸ファイバースコピーにて同部の粘膜の壊死，潰瘍，出血を認めた．虚血性大腸炎と考え，腹部血管造影を行ったところ，下腸間膜動脈に壁不整，狭窄，拡張，途絶を認めた．手掌皮膚の生検より壊死性血管炎の像が得られ，PNと診断した．ステロイドおよびcyclophosphamideで治療し，腸病変は経過中に一部再燃を示しながら治癒した．開腹せずにPNによる虚血性腸病変を確認し，その経過を観察できた症例は極めてまれであるため報告した．

　A 39-year-old man was admitted to our hospital because of abdominal pain and melena. Radiological study of the colon by Gastrografin enema showed mucosal irregularity and tubular narrowing of the transverse colon and the descending colon near the splenic flexure. The colonofiberscopic examination revealed necrosis, hemorrhages and edema of the colonic mucosa. Ischemic colitis was highly suspected and abdominal angiography was performed revealing irregular stenosis, dilatation and obstruction of branches of the inferior mesenteric artery. Histological examination of the biopsy specimen obtained from the palmar erythema showed necrotizing angitis. Based on these findings a diagnosis of periarteritis nodosa was made.

　He was treated with prednisolone and cyclophosphamide. The ischemic lesion of the colon was gradually improved although the temporal aggravation occurred. Other clinical manifestations included testicular pain, leg pain, phlebitis of the left leg and pulmonary infarction.

　It is extremely rare that the ischemic intestinal lesion and its healing process are observed.

　The review of cases of periarteritis nodosa involving the digestive system reported in Japan is also made.