虚血性大腸炎―内視鏡と生検を中心に

Ischemic Colitis with Special Reference to Colonoscopic and Histologic Findings

　Boley¹⁾，Marston²⁾らによって虚血性腸炎が1つの疾患単位として認められるようになったのは比較的最近のことであり，一般にはまだその実態が十分には理解されていないようである．本稿では自験例を中心に，虚血性大腸炎の内視鏡所見と生検所見の代表例を列挙することにより，本症の内視鏡的スペクトルをできるだけ明らかにしてみたい．

　対象は東京大学第1外科，養育院附属病院外科，吉田外科病院において，臨床的に虚血性大腸炎と診断され，内視鏡的に確認された19例であり，いずれも一過性のものである．

　Ischemic colitis is a clinical entity diagnosed by typical clinical symptoms such as sudden bloody stool, diarrhea and abdominal pain. The diagnosis can be confirmed by barium enema examination and/or colonoscopy with biopsy. Although colonoscopic appearances of ischemic colitis are characteristic and diagnostic with edematous-reddish mucosa and shallow irregular ulcerations, occasionally longitudinal, those of penicillin induced colitis are similar to ischemic colitis to a some extent. Histologic appearances are not pathognomonic with goblet cell depletion, some vascular congestion and hemorrhage of the lamina propria. As vascular occlusion is not always noticed, a question has been raised whether clinically diagnosed ischemic colitis is really due to ischemic change. Although pathogenesis of ischemic colitis is not completely clear, it should be recognised as a clinical entity and more detailed study on pathogenesis is to be carried out. The value of colonoscopy and biopsy in confirming the diagnosis of ischemic colitis was stressed.