病変の進行を観察しえた特発性腸間膜静脈硬化症の1例

Idiopathic Mesenteric Phlebosclerosis Colitis with Advancing Pathological Changes, Report of a Case

要旨　患者は77歳，女性．主訴は，右下腹部腫瘤，腹満，腹痛，便秘．大腸内視鏡検査で回盲部～上行結腸は暗紫色調で浮腫状であった．組織学的検査にて，粘膜下層～漿膜にかけて，静脈壁の肥厚と血管周囲性の膠原線維沈着を認めた．Congo red染色像は陰性で，アミロイドーシスは否定的であった．腹部造影CT検査にて肥厚した結腸壁内と腸間膜の石灰化を認め，特発性腸間膜静脈硬化症の診断となった．病因との因果関係は不明であるが，便秘症のため，22年間センナ系下剤を内服していた．最終的に臨床症状が強くなったため手術し，症状の改善に至った．長期的に経過と病変の進行を観察しえた症例である．

　Idiopathic mesenteric phlebosclerosis is a rare disease, and its etiology and clinical course are not well understood. A 77-year-old woman had consumed parts of senna for 22 years ; however, its causal relationship with the disease was unknown. She was admitted to our hospital with complaints of a lower-right abdominal mass, abdominal pain, and constipation. Colonoscopy revealed an edematous and dark purple-colored surface with erosions and an inflammatory polyp from the cecum to the ascending colon. Circumferential collagen deposition around the capillaries of the lamina propria was noted on endoscopic biopsy. Abdominal CT showed diffuse thickening of the intestinal wall and calcification along the intestinal wall and in the mesenterium. Eventually, her clinical symptoms worsened and surgery was performed.