早期静脈相の出現を認めた一過性虚血性大腸炎の1例

Transient Ischemic Colitis with Angiographic Findings of the Early Venous Filling

　高血圧症と陳旧性心筋梗塞を有する高齢者に発症した一過性虚血性大腸炎の1例を報告し，血管造影上興味ある所見を得たので若干の考察を加える．

　症　例

　患　者：61歳，女．

　主　訴：下血，下腹部痛．

　現病歴：1979年1月初めより感冒様症状を訴え，2日間感冒薬を服用した．1月6日夕方より突然激しい腹痛と下痢が始まり，引き続いて下血と嘔吐を繰り返した．下腹部痛は当初持続性で，次いで仙痛となり，漸次間歇期が長くなった．下血と腹痛は1月9日まで続き，本院外科を受診し緊急入院となった．

　This is a case of a 61 year-old female, who had been pointed out to have hypertension fifteen years ago. She was admitted to Kitasato University Hospital on January 9, 1979, with four-day history of cramped abdominal pain associated with frequent bloody diarrhea and vomiting. On physical examination, she was febrile (37.5℃) and there was tenderness in the epigastrium and lower abdomen with no guarding. Rectal examination confirmed the presence of bloody stool. Hemoglobin was 11.6g/100ml, leukocyte count was 6,400, T. P. was 5.5g/100ml and CRP was one positive. ECG showed old inferior myocardial infarction.

　Barium enema, performed at the 4th day after onset, showed loss of distension and bamboo knot appearance at left side of the transverse colon. Selective angiogram of the inferior mesenteric artery did not reveal stenosis nor occulusion of the marginal artery as well as vasa recta, but early venous filling was clearly demonstrated.

　From these findings, she was diagnosed ischemic colitis and treated with intravenous hyperalimentation. Subjective and objective improvements were obtained after the several hospital days.

　We had performed selective mesentric angiography in five cases of ischemic colitis, and recognized the findings of the early venous filling in three cases, in which two cases of ulcerative form of ischemic colitis were included.