狭窄をきたした虚血性大腸炎の1例

Ischemic Stricture of the Sigmoid Colon, a Case Report

　虚血性大腸炎は種々の原因による大腸虚血の結果起こる非特異性炎症性疾患とされている．その概念は1960年代に提唱されたが，本邦での報告例は18例にすぎない^1)～8)．またそれらの病理学的所見は比較的簡単に記載されているように思われる．われわれは狭窄をきたした虚血性大腸炎の1例を経験したので，その病理学的所見に重点をおいて報告する．

症　例

　患　者：75歳　男性

　主　訴：腹痛

　既往歴：73歳の時，老人検診にて高血圧を指摘された．以来，時々降圧剤を服用していた．

　家族歴：特記すべき事項はない

　現病歴：1976年9月25日，夕食前に降圧剤を服用したところ，同日午後6時頃より突然腹痛が起こり，嘔吐，下痢も出現した．血性下痢，血便はなかった．近医を受診し，入院精査の結果，①イレウス（結腸癌の疑い），②心房細動の診断にて当院外科に紹介された．前医での検査成績は白血球増多（10,100，好中球89％）を除いて著変はなかった．

　A 75-year-old man was admitted due to complaints of sudden abdominal pain with diarrhea and vomiting. He had been pointed out to have hypertension since two years before and his electrocardiogram had shown atrial fibrillation with scattered ventricular premature beats. Labolatory examination revealed leukocytosis, and serum alkaline phosphatase, lactate dehydrogenase and γ-glutamyl transpeptidase were elevated slightly. A segmental stricture with mucosal irregularity and pseudodiverticle-like sacculation were found by barium enema from the sigmoid up to the lower half of the descending colon. Because obstructive symptoms did not subside, operation was performed four weeks after the onset. Cardiac failure occurred after the operation, but digitalis and diuretics helped him. Since then his clinical course was uneventful.

　The resected colon had a 20 cm-long portion of stricture with thickened wall, which was segmenta and well-defined. Histological examination revealed loss of mucosal glands, and the submucosal layer was widened due to proliferation of the granulation tissue with hemorrhage. Necrosis of the muscle layer was detected and inflammatory changes extended to the subserosal fatty tissue. Hemosiderin-laden macrophages were scattered in the lesion. A recanalizated artery was recognized in the subserosa.