術前に小腸間膜内穿通と診断し腹腔鏡補助下手術を施行した結節性多発動脈炎の1例

Laparoscopically assisted surgery of polyarteritis nodosa with penetration of small intestine to mesostenium : A case report

◆要旨：患者は66歳，女性．腹部膨満，嘔吐を主訴に腸閉塞の診断で当院を紹介され受診した．減圧後のイレウス管造影で小腸に約5cm長の不完全狭窄像を認め，腹部CTで同部位の小腸間膜内にガス像を認めた．小腸の間膜内穿通に伴う消化管通過障害を疑って手術を施行した．腹腔鏡下に小腸の穿通部位を同定し，小開腹で小腸部分切除術を行った．病理組織学的検査を踏まえて結節性多発動脈炎（polyarteritis nodosa：PAN）と診断した．術後経過は問題なく，内科でステロイド内服治療を導入し，以降再発なく経過している．PANによる小腸間膜内穿通の報告はなく，腹腔鏡下手術による治療を行った貴重な症例と考えられ報告する．

　A very rare case of polyarteritis nodosa （PAN） with penetration of the small intestine to the mesostenium treated by laparoscopically assisted surgery is herein reported. A 66-year-old woman was admitted with the chief complaints of abdominal distention and vomiting. Radiologic enteroclysis after decompression used the long intestinal tube revealed incomplete stenosis at the small intestine. Abdominal CT revealed parenteral gas in the mesostenium. Penetration of the small intestine to the mesostenium was suspected and laparoscopically assisted surgery was performed. Penetration site was detected laparoscopically, and partial resection of the small intestine was performed by minilaparotomy. Histologically, the lesion of the ulcer was diagnosed as PAN. Postoperative course was uneventful. Oral administration of steroid was started, and the patient was discharged 11 days after surgery. There has been no recurrence.