診断に難渋した放射線腸炎の1例 A Case of Radiation Sigmoiditis Diagnosed by a Characteristic Pathological Finding

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著者

    • 鎌田 紀子 KAMATA N.
    • 大阪市立大学大学院医学研究科消化器器官制御内科学(第三内科) Department of Gastroenterology, Osaka City University Graduate School of Medicine
    • 押谷 伸英 OSHITANI N.
    • 大阪市立大学大学院医学研究科消化器器官制御内科学(第三内科) Department of Gastroenterology, Osaka City University Graduate School of Medicine
    • 大磯 龍太 OISO R.
    • 大阪市立大学大学院医学研究科消化器器官制御内科学(第三内科) Department of Gastroenterology, Osaka City University Graduate School of Medicine
    • 河内屋 友宏 KAWACGUTA T.
    • 大阪市立大学大学院医学研究科消化器器官制御内科学(第三内科) Department of Gastroenterology, Osaka City University Graduate School of Medicine
    • 稲川 誠 INAGAWA M.
    • 大阪市立大学大学院医学研究科消化器器官制御内科学(第三内科) Department of Gastroenterology, Osaka City University Graduate School of Medicine
    • 川島 大知 KAWASHIMA D.
    • 大阪市立大学大学院医学研究科消化器器官制御内科学(第三内科) Department of Gastroenterology, Osaka City University Graduate School of Medicine
    • 十河 光栄 SOGAWA M.
    • 大阪市立大学大学院医学研究科消化器器官制御内科学(第三内科) Department of Gastroenterology, Osaka City University Graduate School of Medicine
    • 神野 良男 JINNO Y.
    • 大阪市立大学大学院医学研究科消化器器官制御内科学(第三内科) Department of Gastroenterology, Osaka City University Graduate School of Medicine
    • 澤 禎徳 SAWA Y.
    • 大阪市立大学大学院医学研究科消化器器官制御内科学(第三内科) Department of Gastroenterology, Osaka City University Graduate School of Medicine
    • 中村 志郎 NAJANYRA S.
    • 大阪市立大学大学院医学研究科消化器器官制御内科学(第三内科) Department of Gastroenterology, Osaka City University Graduate School of Medicine
    • 松本 誉之 MATSUMOTO T.
    • 大阪市立大学大学院医学研究科消化器器官制御内科学(第三内科) Department of Gastroenterology, Osaka City University Graduate School of Medicine
    • 荒川 哲男 ARAKAWA T.
    • 大阪市立大学大学院医学研究科消化器器官制御内科学(第三内科) Department of Gastroenterology, Osaka City University Graduate School of Medicine

抄録

症例は65歳女性.既往歴として,39歳時に子宮癌の手術と放射線治療が行われている.元来便秘症であった.数日間の便秘の後,突然の下腹部痛と1日数回の下血が出現し,大腸内視鏡検査にて肛門より約30cmのS状結腸に下掘れ状の類円形潰瘍を認めた.絶食,中心静脈栄養管理を開始したが,症状の改善は見られなかった.その後の生検組織検査にて間葉系に異型性細胞"owl-eye-appearance"を認め,病歴と内視鏡像,及び病理学的所見から放射線腸炎と診断した.放射線腸炎は直腸前壁に好発し,S状結腸には8.8%と少ない.本例は非定型的であったが,生検組織検査が診断に有用であった.

A 65-year-old woman was referred to our hospital because of an intractable sigmoid colon ulcer. She had undergone a right nephrectomy for kidney stones, at age 33, and a uterectomy at age 39, followed by radiation therapy. Lower abdominal pain and hematochezia developed suddenly, following a few days of constipation, in September 1999, when she was admitted to the previous hospital because of left hydronephrosis. A punched-out oval ulcer was found in the sigmoid colon, on colonoscopic examination. She was treated with total parenteral nutrition, prednisolone, and mesalazine administration. Although her hematochezia and abdominal pain disappeared, diarrhea and abdominal pain occurred after she began eating, and she was referred to our hospital for further examination. Although intestinal lavage solution was used for bowel preparation, stercoromas were found in the rectum, which had to be manually removed before colonoscopic examination, and a stercoral-ulcer was suspected. The sigmoid colonic ulcer was intractable. A biopsy specimen, taken from the bottom of the ulcer, revealed bizarre interstitial cells, each with a large oval nucleus, showing the so-called "owl-eye-appearance." Although the diagnosis of radiation sigmoiditis is sometimes difficult, "owl-eye-appearance" is a useful pathological finding in the diagnosis of late-phase radiation-induced colitis.

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 55(5), 229-233, 2002-05-01

    The Japan Society of Coloproctology

参考文献:  17件中 1-17件 を表示

被引用文献:  1件中 1-1件 を表示

各種コード

  • NII論文ID(NAID)
    10008582541
  • NII書誌ID(NCID)
    AN00195100
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    00471801
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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