Terminal hemorrhagic necrotizing enteropathy（急性偽膜性腸炎）の1剖検例

ONE CASE OF NECROPSY OF TERMINAL HEMORRHAGIC NECROTIZING ENTHEROPATHY PATIENT.

Ⅰ．緒言

　PennerとBernheim¹⁾（1939）が手術後の患者の腸管に出血性の壊死が多発して，しかも上および下腸間膜動脈および静脈の内腔に閉塞のない疾患を記載し，acute postoperative enterocolitisと命名した．夫妻は，この疾患の病因をショックに求め，ショック時の腸管に血管の虚脱状態が起こり，乏血のために腸管壊死が発生すると考えた．その後，この病因論の当否について，多くの議論が起こり，と同時に疾患の呼称についても，Pseudomembranous enterocolits（Baggenstossら²⁾1954）を始めとして，近くはnonocclusive mesenteric ischemia（Fogarty，Fletcher³⁾1966），terminal hemorrhagic necrotizing enteropathy（Bhagwat，Hawk⁴⁾1966）など多彩な名称が用いられている．最近米国を中心としてこの疾患の病因論が再び活発な議論を呼び，10年以前の病因論よりもはるかに高いレベルで，討議されている．

　米国での本疾患の発生は，それほど稀なものではなく，すでに500例近い報告があり，剖検体数の0.6％⁵⁾から0.8％⁴⁾の出現率にあたるようであるが，本邦での発生は，欧米に比べてはるかに少なく，死後に剖検した報告例は，最近10年間にわずか10数例^6)7)8)9)に過ぎない．

　長らく胆石症に悩み，最後の発作直後から下腹部激痛，ショック，穿孔性腹膜炎を起こし，直ちに開腹して回腸切除を行ったが，19日目に死亡した1例を経験し，剖検したので報告する．

　The patient was fifty eight years old male. He had had a gall bladder operation two years before. But stones were still noticed in the bile duct after the operation. He had a slight epigastric pain and the jaundice some times. At the last attack, the necrosis of intestine without the occulusion of vessels and the shock happened. Resection of terminal ileum was undertaken but the patient died 19 days after. This was neither pseudomembranous enterocolitis which usually happens 3 or 4 days after the operation nor enterocolitis accompanied with heart disease. Perhaps low blood pressure following the attack or the stasis in the portal vein was direct provoking cause of the necrosis of the intestine. There are many names given to this kind of disease. In U.S.A., this disease is not so rare and almost 500 cases were reported, but in our country, only some ten cases were reported. Etiology was studied by consulting with academic reports. Nowadays they agreed that the main cause of this disease is the disturbance of circulation at intestinal wall. One case of terminal hemorrhagic necrotizing enteropathy was reported and the etiology and histological findings were considered.