虚血性十二指腸・空腸炎の1例

Ischemic Duodenojejunitis Due to Septic Shock, Report of a Case

要旨　患者は48歳，女性．1988年7月某医で左甲状腺癌摘出術後の化学療法施行直後にショック状態となり急性腎不全，大量の消化管出血を来し，同年9月当科入院．腹部血管撮影で異常なく，小腸X線・内視鏡検査にて，十二指腸第2部から上部小腸にかけて著明な浮腫と多発する深い潰瘍を認めた．中心静脈栄養にて1か月後に下血が消失し，潰瘍は縮小したが，空腸上部の狭窄が高度となったため同部を切除した．切除標本では炎症所見とヘモジデリン沈着が認められ，虚血性小腸炎と診断した．虚血の原因としては敗血症性ショックが考えられた．

　A 48-year-old woman was admitted to our hospital with chief complaints of vomiting and melena. She underwent total thyroidectomy for thyroid cancer at another hospital and had been treated with chemotherapy including fluorouracil and aclarubicin. Three weeks later, pancytopenia developsed, followed by fever, septic shock, renal failure, and melena. The latter was too massive to control with conservative treatment, she was transferred to our hospital. Double contrast small bowel x-ray study revealed multiple ulcers, severe edema, and luminal narrowing in the distal duodenum and upper jejunum. Endoscopic examination showed mucosal granularity and circumferential ulceration in the distal duodenum. Her melena disappeared with total parenteral nutrition. Follow-up radiographic and endoscopic examination demonstrated a marked stenosis of the distal duodenum and multiple longitudinal or girdle-like ulcers of the upper jejunum. She underwent duodenojejunectomy because of severe stenosis. The resected surgical specimen showed multiple sharply demarcated ulcers with neighboring edematous mucosa. Histological findings were compatible with those of ischemic enteritis. In the present paper, serial radiographic and endoscopic findings of this case were described.