狭窄型を呈した虚血性腸炎の1例

Stricture Ischemic Colitis

　本邦では第20回日本消化器病学会秋季大会（於：岐阜，1978. 10）のシンポジウムにおいて“消化管と血管病変”が取り上げられて以来，いわゆる虚血性腸炎に対する関心が高まり，症例報告が集積されつつある．私たちも本邦では比較的まれとされている狭窄型の虚血性腸炎を経験したので報告する．

　症　例

　患　者：74歳，女，主婦．（厚生院　No.1473）

　主　訴：左下腹部痛．

　既往歴：44歳で子宮筋腫の手術．

　現病歴：1980年3月19日就眠時，突然左下腹部に鈍痛を自覚．疼痛は腹部全体に拡がり，嘔気，発熱，下血を伴ってきたため同3月21日名古屋市厚生院へ入院．

　A 74 year-old woman was admitted to Nagoya Geriatric Hospital because of sudden lower abdominal pain. There was Blumberg's sign on the left frank, but the bowel sounds were not hyperactive. An abdominal plain film showed a dilated and deformed colon gas on the left upper quadrant.

　Gastrografin enema of the colon revealed thumb prints and pseudopolypoid changes in the splenic flexure area, suggesting ischemic colitis. Aortogram demonstrated sclerotic changes of the abdominal aorta and the complete occlusion of the inferior mesenteric artery. Selective angiogram of the superior mesenteric artery demonstrated a well-established collateral pathway between the middle colic artery and the right colic artery.

　From these findings, a diagnosis of ischemic colitis was made. Follow-up study by barium enema showed tubular narrowing, sacculation and multiple scars in the descending colon. Stricture ischemic colitis was finally diagnosed.