横行結腸の穿通性潰瘍に起因する大網・小網のひきつれにより胃前庭部狭窄を呈した1例 A Case of Penetrated Ulcer in Transverse Colon Presenting Antral Stenosis due to Retraction of Lesser and Greater Omentum

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著者

    • 丸田 守人 MARUTA M.
    • 藤田保健衛生大学消化器外科 Department of Surgery, Fujita Health University School of Medicine
    • 洪 淳一 KOH J.
    • 社会保険埼玉中央病院外科 Department of Surgery, Social Insurance Saitama Chuo Hospital
    • 堀部 良宗 HORIBE Y.
    • 社会保険埼玉中央病院・病理 Department of Pathology, Social Insurance Saitama Chuo Hospital

抄録

胃前庭部の狭窄による急性胃拡張症状にて発症し,手術により横行結腸潰瘍穿通に起因する小網,大網のひきつれによる胃前庭部狭窄と判明した1症例を経験したので報告する.症例は72歳の女性で,上腹部痛と嘔気を主訴に来院した.上部消化管造影検査で胃前庭部の高度の狭窄を認め,内視鏡では病変の確認はできなかったため胃癌による胃前庭部狭窄の疑いで手術を施行した.開腹所見では肛門側横行結腸に狭窄を認め,同部に小網,大網が索状にひきこまれ,胃前庭部の狭窄を引き起こしていたため横行結腸切除術を行った.切除標本では腸管の横軸方向に辺縁が鋭な下掘れ状の潰瘍を認め,組織学的には潰瘍周囲の肉芽と炎症性細胞浸潤を伴うUL4の潰瘍で悪性所見はなかった.潰瘍底付近には,ヘモシデリンの沈着や小血管内の血栓および血管内膜の肥厚などの所見が認められ,限局性の循環障害による虚血を伴った潰瘍と考えられた.

A patient with acute gastric dilatation due to antral stenosis underwent surgery, and it was revealed that stenosis was induced by retraction of the lesser and greater omentums resulting from colonic ulcer penetration. A 72-year-old female was admitted due to complatints of upper abdominal pain and nausea. Radiological study of the upper gastrointestinal tract revealed severe stenosis of the antrum, but endoscopic examination could not confirm the lesion. Operation was performed after a diagnosis of suspicious gastric cancer. Laparotomy revealed a stenotic lesion of the left side of the transverse colon which induced retraction of the lesser and greater omentums, forming an antral stenosis. Resection of the treanseverse colon was done, and a circular ulcer with a sharp margin penetrating to the serosal layer was observed in the resected specimen. Histological examination revealed a UL 4 ulcer with granulation and inflammatory cell infiltration without malignancy. Sedimentation of hemosiderin, thrombosis of the smaller vessels, and hypertrophy of the internal membrane of the vessels were also obsergved. Isebemic mechanism was suggested to be associated with the formation of the ulcer.

収録刊行物

  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 50(2), 106-110, 1997-02-01

    The Japan Society of Coloproctology

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