S状結腸捻転を起こし切除した腸管嚢胞状気腫症の1例

Pneumatosis Cystoides Intestinalis Accompanied with Sigmoid Volvulus, Report of a Case

要旨　患者は82歳，男性，鉄欠乏性貧血の原因検索により，S状結腸の腸管嚢胞状気腫症(PCI)と判明し経過観察していたが突然のイレウス症状にて来院した．腹部立位写真の結果，S状結腸捻転による絞扼性イレウスと診断し，開腹切除した．本例におけるPCIの原因としては陳旧性肺結核に起因する慢性閉塞性肺疾患の存在が考えられた．またS状結腸捻転によりPCIが惹起された例は報告されているが，本例のようにPCIの存在が先行し，その後S状結腸捻転を生じた報告例は本邦では初めてである．PCIの存在により腸管が浮揚，過長したことが原因であると想定された．

　An 82-year-old male patient was admitted to our hospital complaining of severe abdominal pain and constipation. Abdominal x-ray films demonstrated a greatly distended colon on the left side, indicating a volvulus of the sigmoid colon. He underwent laparotomy and resection of the sigmoid colon about 40 cm in length.

　He had been previously shown to have pneumatosis cystoides intestinalis (PCI) in the sigmoid colon. Barium enema showed a remarkably elongated sigmoid colon, in which many elevated lesions with smooth surfaces in various sizes were seen (Fig. 2). Colonoscopic examination also showed the same lesions with slight redness and erosion (Fig. 3).

　The resected specimens coincided with roentogenological and endoscopic findings and there were many gasfilled cysts in the submucosal layer (Fig. 6).

　The etiology of PCI is not clear. Chronic obstructive pulmonary disease seemed to be one of the etiologies in this case.

　Sigmoid volvulus is also reported to be one of the etiologies of PCI. In Japan, this may be the first report of PCI preceding sigmoid volvulus.