壊死型虚血性腸炎の臨床像

Clinical Features of Gangrenous Ischemic Enteritis

要旨　虚血性腸炎の中で，全層性の虚血性壊死を来し，絶対的手術適応である壊死型虚血性腸炎は，一過性型や狭窄型に比べてその頻度は低いものの，腹膜炎症状を呈する．特に，壊死型虚血性大腸炎では緊急手術を行っても，敗血症・多臓器不全・DICなどの周術期合併症が多く予後不良の症例に遭遇する．術前診断は困難なことが多いが，救命率を上げるために，本症を含めた腸管虚血性疾患に対する的確な早期診断・早期治療とともに術式の選択・術後合併症対策が重要である．

　GIE（gangrenous ischemic enterocolitis）, which causes transmural bowel necrosis and mandates surgical approach, is rather rare among total cases of IE. Even after adequate resection of the responsible intestine with necrosis, high mortality remains the hallmark in GIE, because of peri-operative severe complications, such as sepsis, multiple organ failure, and DIC. It is hard to make a definite diagnosis as GIE pre-operatively. To improve prognostic outcome in patients with GIE, we have to consider the possibility of these ischemic bowel diseases, and have to make a prompt and appropriate therapeutic strategy, including operative method and peri-operative intensive care-planning.