腹膜刺激症状を呈した重症偽膜性腸炎の2例 Two Cases of Pseudomembranous Colitis with Peritonitis
腹膜刺激症状を呈した偽膜性腸炎の2症例を経験した. 症例1は72歳, 女性. 気管支炎に対しTFLX, CFPN-PI投与後, 発熱, 下痢が出現し当科紹介, 感染性腸炎が疑われLVFXを投与されたが悪化したため入院となった. 症例2は62歳, 女性. 当院泌尿器科にて腹腔鏡下右副腎腫瘍摘出術施行後2週間目より腹痛, 下痢が出現し当科に紹介となった. 2症例とも経過中に腹膜刺激症状が出現し, 腹部CT検査で著明な上行結腸の壁肥厚と下部消化管内視鏡検査で偽膜を認めた. ともに偽膜性腸炎と診断し, 各々MNZ, VCMを投与し軽快した. 偽膜性腸炎は, 下部消化管内視鏡検査や<i>Clostridium difficile</i> (CD) toxinの検出により容易に診断されるが, 時に重症化し腹膜刺激症状を呈することがあるので注意が必要である.
We experienced two cases of pseudomembranous colitis (PMC) with peritonitis.<br>Case 1 : A 72-year-old Japanese woman complained of diarrhea after taking antibiotics (TFLX, CFPN-PI) because of bronchitis. We diagnosed her as PMS by colonoscopy. After taking VCM, her condition improved.<br>She took some antibiotics due to urinary tract infection about two weeks later, and complained of severe abdominal pain without diarrhea. Rebound tenderness and high fever suggested that she had peritonitis. Colonoscopy revealed recurrent PMC. Metronidazole was effective and she was discharged from our hospital.<br>Case 2 : A 62-year-old Japanese woman had severe abdominal pain with diarrhea. She had also rebound tenderness. Diagnosis as PMC was made by colonoscopy. It was revealed later that LVFX had been medicated by another doctor. After taking VCM, she became well and was discharged from our hospital.<br>Although it is usually easy to diagnose PMC, peritonitis may follow without adequate diagnosis and treatment. Marked wall thickening of the ascending colon was characteristic in our two cases.
日本大腸肛門病学会雑誌 60(3), 151-155, 2007-03-01
The Japan Society of Coloproctology