一過性虚血性大腸炎の1例

A Case of Transient Ischemic Colitis

　近年，虚血性大腸炎の概念の定着に伴い，本邦報告例は漸増している．しかし，本症のなかで，最も頻度が高いといわれる一過性の病変は，発病初期だけにしか所見が現れないため，検査の時期を失してしまうと診断が困難になる．このため病因不明の病変として片付けられている症例もかなりあると思われる．

　われわれは最近，X線・内視鏡的に経過を観察できた一過性虚血性大腸炎を経験したので報告する．

　A 56-years-old man, who had been pointed out to have hypertension since ten years ago, but had not been treated, was admitted to Hikari City Hospital because of sudden mucous diarrhea. Stools had been mixed with copious fresh blood for four days after the onset. Abdominal discomfort was also accompanied.

　On physical examination, the blood pressure was 206/108 mmHg. There was slight tenderness on the epigastrium, but the bowel sounds were not hyperactive. A sigmoidoscopic examination did not reveal any abnormal finding. Barium enema showed serration and thumbprinting from the ascending to the half of the transverse colon with loss of haustral pattern and contraction of the lumen. Colonofiberscopic examination showed multiple irregular shallow ulcers, and the surrounding mucoua with redness and swelling. Cecum was normal. Histological examination revealed dilated capillary blood vessels and submucosal hemorrhage without haemosiderin-laden macrophages. Stools were negative for tubercle bacilli on four successive occasions. Symptomatic treatment for a diagnosis of ischemic colitis improved melena rapidly, and occult blood also became negative. Several ulcer scars and slight deformity were seen by barium enema on the 34 th hospital day. Endoscopic examination also showed several ulcer scars and mucosal redness.