慢性膵炎急性増悪による結腸狭窄の1例 A Case of Colonic Stenosis Accompanying an Acute Exacerbation of Chronic Pancreatitis

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慢性膵炎急性増悪による結腸狭窄の1例を経験した.症例は52歳,男性.急性膵炎にて入院の既往がある.上腹部痛を主訴に来院.白血球数,血清アミラーゼ値の上昇を認め,慢性膵炎急性増悪の診断にて入院となった.入院後,DICを併発し一時ショック状態となったが保存的に軽快.しかし,イレウス症状出現したためイレウス管挿入し,減圧を行った.注腸造影検査,イレウス管造影検査では横行結腸,上行結腸,盲腸の3箇所に狭窄を認めたが,バリウムの通過は比較的容易であった.大腸内視鏡検査では横行結腸に全周性の狭窄を認め,内視鏡は通過しなかった.その後も保存的に治療を行ったが軽快せず,約3カ月後に右半結腸切除術を施行した.病理組織学検査では粘膜下層から筋層に強い炎症所見と線維化を認めた.膵炎による腸管狭窄は,症状発現後3カ月程度の保存的治療で軽快しないものに対しては,外科的処置の必要があると思われた.

We report a case of colonic stenosis complicated by an acute exacerbation of chronic pancreatitis. A 52-year-old man, who had a history of hospitalization for acute pancreatitis, visited our hospital complaining of upper abdominal pain. As blood leukocytes and the serum amylase were elevated, he was admitted with a diagnosis of an acute exacerbation of chronic pancreatitis.<BR>After admission, biochemical examination revealed disseminated intravascular coaguration (DIC), and the patient gradually progressed to a state of shock. Although the shock state was improved, a symptom of bowel obstruction appeared, and a long tube was inserted. Barium enema and gasrographin through long-tube examination revealed a stenosis at the transverse, ascending colon and cecum, but barium passed through the stenosis. A colonoscope did not pass through the stenosis at the transverse colon. As conservative treatment for three months was not successful, a right hemicolectomy was performed. Histologically, severe inflammatory change and fibrosis were shown in the submucosal and proper muscle layer. An intestinal stenosis complicated by pancreatitis may be treated by surgery after conservative therapy for three months has failed.

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  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 55(1), 38-42, 2002-01

    The Japan Society of Coloproctology

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