大腸病変をともなった結節性多発動脈炎の1例 : 本邦報告例の検討 A Case of Polyarteritis Nodosa with Stenosis of the Sigmoid Colon

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著者

    • 河野 文彰 KAWANO F.
    • 宮崎大学医学部循環呼吸総合外科学 The Cardiovascular, Thoracic and General Surgery, Miyazaki University School of Medicine
    • 関屋 亮 SEKIYA R.
    • 宮崎大学医学部循環呼吸総合外科学 The Cardiovascular, Thoracic and General Surgery, Miyazaki University School of Medicine
    • 篠原 立大 SHINOHARA T.
    • 宮崎大学医学部循環呼吸総合外科学 The Cardiovascular, Thoracic and General Surgery, Miyazaki University School of Medicine
    • 鬼塚 敏男 ONITSUKA T.
    • 宮崎大学医学部循環呼吸総合外科学 The Cardiovascular, Thoracic and General Surgery, Miyazaki University School of Medicine

抄録

大腸病変をともなった結節性多発動脈炎(polyarteritis nodosa: 以下PN)の1手術例を報告し,大腸病変をともなった本疾患の本邦報告例を集計し,その特徴を検討した.症例は60歳,男性.大腸狭窄の精査にて当院に入院となった.大腸内視鏡検査にてS状結腸に高度の狭窄を認め,腹部CT検査では脾動脈瘤,腎動脈および肝内動脈瘤を認めた.さらに血管造影では下腸間膜動脈領域に多発する動脈瘤とS状結腸動脈の閉塞を認めた.PNにともなうS状結腸狭窄の診断のもと手術を施行した.S状結腸には狭窄を認め,同部位に小腸と虫垂の癒着を認めた.また肉眼的には明らかな結腸漿膜の虚血性変化を認めなかったが,レーザー血流計を用い血流を評価し左側結腸切除を行った.胃,十二指腸,小腸および右側結腸には明らかな病変を認めなかった.病理組織診断では粘膜下層を中心とした小型·中型の動脈壁の肥厚·内腔の狭細化をきたしておりPNと診断した.<br>

We report a case of polyarteritis nodosa with stenosis of the sigmoid colon. A 60-year-old man was admitted to the hospital complaining of abdominal pain and high fever. Although he received medical treatment, his symptoms did not improve. Barium enema and colonoscopy revealed severe stenosis and mucosal redness of the sigmoid colon. Abdominal CT scan showed splenic artery aneurysms and small hepatic artery aneurysms. Celiac and right renal arteriography showed small multiple aneurysms. Moreover, inferior mesenteric arteriography showed occlusion of the sigmoidal arteries and aneurysms of branches of the left colic and the superior rectal artery. From the results, stenosis of the sigmoid colon was diagnosed preoperatively and an operation was performed. During the operation, contraction of the sigmoid colon, thickening of the mesocolon and adhesion of the ileum to the sigmoid colon were found. Although ischemic change of the serosa of the colorectum was not recognized, the left colon measuring 23cm in length was resected while assessing the circulation with a laser flowmeter. His postoperative course was uneventful. We diagnosed polyarteritis nodosa from the findings of the pathologic specimens. Although the gastrointestinal tract is frequently involved in polyarteritis nodosa, it is relatively rare to involve the colorectum. We retrospectively reviewed 22 cases with polyarteritis nodosa involving the colorectum in the Japanese literature. <br>

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 61(1), 39-45, 2008-01-01

    The Japan Society of Coloproctology

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