頻回な再燃のため手術を施行した右側結腸憩室症の1例

Right-sided Diverticular Disease of the Colon Which Required Operation Because of Frequent Flare-ups

　従来より右側結腸憩室炎は左側に比して重篤な合併症を併発することが少なく，保存的療法で寛解するといわれている．しかし最近右側結腸憩室炎でも左側結腸憩室炎と同様に多発性で，壁の硬化，腸管の短縮，変形を伴う仮性憩室の症例がしばしば経験されるようになり，われわれはこのような症例5例に切除手術を施行している．本稿では，4年間follow upしたが，再燃を繰り返した末に手術を施行した右側結腸憩室炎症例を報告する．

　症　例

　患　者：60歳　男性　会社員

　主　訴：回盲部痛，右下腹部腫瘤，発熱

　既往歴：10年前より高血圧にて降圧剤服用

　家族歴：父親が胃癌にて死亡

　現病歴：1976年12月右下腹部痛，発熱（37℃台）にて近医受診，急性虫垂炎の診断のもとに抗生物質の投与を受け症状は軽快した．この時白血球増多を認めた．翌1977年は，時々右下腹部に軽度圧痛があるも消化剤の内服にて軽減したために放置しておいた．1978年1月中旬～3月にかけ右下腹部痛，発熱を繰り返したため近医にて解熱剤，抗生物質の投与を受けた．3月下旬になり38℃台の発熱，右下腹部痛の増強，白血球増多（12,000）を認めたためクローン氏病の疑いにて消化器病センターを紹介され来院す．

　Diverticulitis of the right side of the colon has been said to have less serious complications than the left-sided one and can be controlled by conservative treatment. However, some diverticulitis of the right side of the colon also have been noted to have muscle abnormalities as seen in the left-sided diverticulitis. In these cases, conservative treatment may ameliorate patients' symptoms but tend to have flareup of symptoms or inflammation after excess eating and drinking, physical exhaution and stressful situation. Therefore, if there is marked organic change of the colon, they should be operated on.

　The patient was a 60 year-old male who was first seen by local medical doctor in December 1976 because of right upper quadrant abdominal pain and fever. A diagnosis of appendicitis was made and symptoms were resolved by treatment. In 1977, he had intermittent lower abdominal pain but the symptom responded to digestives. In March, 1978, he came to our institution because of right lower quadrant abdominal pain and fever (39℃) and a hand sized mass was found in the right lower quadrant and leukocytosis (9,100) was also noted. He was hospitalized and barium enema was performed after improving symptoms by concervative treatment. The barium enema disclosed multiple diverticulae, serration, ridigity of the wall and deformity in the cecum and ascending colon, therefore multiple diverticulitis of the right side of the colon was diagnosed and conservative treatment was continued, then he was discharged with remission.

　At the end of March 1979 he was again hospitalized with right lower quadrant abdominal pain, right lower quadrant mass, fever (39℃) and leukocytosis (17,000). It was felt that the patient had flare-up of the diverticulosis at that time. Because of frequent flare-ups of diverticulutis for over the last 4 years as well as marked organic change of the colon, the patient was felt to have surgical indication. Laparotomy was performed and it disclosed shortening of the cecum and ascending colon forming a hand-sized mass which was stiff as a cancerous tumor. Resected specimen showed rigid and deformed cecum with hypertrophic wall. Post-operative course was excellent and he could return to his normal life style 2 months after the operation.