分娩後発症した虚血性小腸炎の1例

Ischemic Enteritis Occurred Following Delivery

　最近，われわれは，分娩を契機として発症した小腸に限局し慢性の経過と紐状狭窄を呈した虚血性腸炎のまれな1例を経験したので，若干の考察を加え，報告する．

　症　例

　患　者：34歳，女．

　主　訴：腹痛．

　既往歴：3年前，子宮内膜症を指摘されている．2年前，不全流産にてD＆C施行．

　家族歴：特記すべき事項はない．

　現病歴：1979年8月6日第2子正常分娩（妊娠38週，第2頭位）．その直後から食後の心窩部不快感あり，同年8月10日夕食後より急激に嘔吐を伴う激しい上腹部痛と右下腹部鈍痛が出現した．排便により腹痛は軽減している．8月24日近医で上部消化管造影を施行する．バリウムの排出が悪く，翌日から腹痛のため，同院に3週間入院．10月には，下痢と体重減少（8kg/2M）が加わり，本院受診．食事摂取困難，脱水著明にて，10月16日本院内科に入院した．血便，背部痛は認めていない．

　This is a case of a 34 year-old woman. Four days after normal delivery of her 2nd child in August 1979, all of a sudden she began to have severe epigastralgia with vomitting as well as dull pain in the right lower abdomen. The upper G. I. series revealed a hard string-like stenosis in the distal ileum and irregular mucosal pattern on its oral side. In November, a partial resection of the small intestine and right adnexectomy was performed for the persistent stenotic symptoms and adhesion, respectively. Stenosis of 5 cm length was found 40 cm oral from Bauhin's valve: histo-pathological examination revealed remarkable fibrosis and proliferation of granulation tissue on the intestinal wall as well as hypertrophy of mesenteric arterial and venous walls and stenosis of their lumens. This case might have been complicated with an adnexitis, but judging from the following findings, adnexitis was presumedly caused secondarily by underlying ischemic enteritis:

　1) manual separation of the adnexa was performed quite easily under the knife;

　2) grade of inflammation was slight on the mesenteric side;

　3) relatively string-like circumferential inflammation was found more on the outside of the Fallopian tube than the inside lumen.

　4) histologically, ischemic change was observed segmentally and circumferentially, with fissuring ulcer.

　The onset of this case was presumedly caused by labor, relaxation of abdominal wall, change in abdominal muscular pressure, intestinal movement and change in intra-abdominal pressure, and partially by blood flow disturbance somewhere near the lesion causing ischemic changes.