虚血性小腸炎(狭窄型,壊死型)の2例 TWO CASES OF ISCHEMIC ENTERITIS OF THE SMALL INTESTINE

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虚血性小腸炎は稀な疾患で,一過性型,狭窄型,壊死型に分類され,一過性型と狭窄型が狭義の虚血性腸炎とされるが, これらは虚血程度の差から生じた重症度の違いだけであると考えられる.狭窄型と壊死型の虚血性小腸炎を経験したので報告する.<BR>症例1は77歳男性.腹痛と嘔吐が出現し保存療法にて改善したが,経口摂取後にイレウス症状が再燃する状態を3回繰り返し,初回発症から52日目紀手術した.回腸が15cmにわたり全周性の壁肥厚と求心性の内腔狭窄をきたし,小腸部分切除術を施行した.病理ではU1-IIの広い潰瘍と高度の線維化を認め,狭窄型の虚血性小腸炎と診断された.<BR>症例2は68歳女性.腹膜刺激症状を伴った腹痛を認め緊急手術を施行した.上腸間膜動脈主幹の血流は良好であったが,空腸が15cmにわたり全層性,全周性に出血性壊死をきたしており,小腸部分切除術を施行した.

Ischemic enteritis of the small intestine is a rare entity and is classified into temporary, stricturing, and gangrenous forms. The temporary and stricturing forms are called ischemic enteritis of the small intestine in a narrow sense, but we think that these forms might be different in the severity resulting from the degree of ischemia. Here we report two cases of ischemic enteritis of the small intestine, one case of stricturing form and the other of gangrenous form.<BR>Patient 1, a 77-year-old man, was admitted to the hospital because of abdominal pain and vomiting. Conservative treatment improved these symptoms and he was discharged from the hospital. However, he was readmitted because of intestinal obstruction. Fifty-five days after the onset of the first symptoms, a laparotomy was performed and a whole circumferential stenosis about 15 cm in length was found at the ileum. Histopathological examination showed U1-II widespread ulcer with marked infiltration of inflammatory cells and fibrosis. The definite diagnosis of ischemic enteritis was made.<BR>Patient 2, a 68-year-old woman, underwent an emergency laparotomy for peritonitis. Pulsation at the main branches of the superior masenteric artery were palpable. Hemorrhagic necrosis of the jejunum about 15 cm in length occurred whole circumferentially and through the entire layers of the intestinal wall. A partial resection of the small intestine was performed.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 62(2), 410-414, 2001-02-25

    日本臨床外科学会

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各種コード

  • NII論文ID(NAID)
    10008388158
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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