外科的切除により治癒したS状結腸腸間膜脂肪織炎の1例 A Case of Panniculitis of the Sigmoid Colon Recovered with Surgical Treatment

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著者

    • 平松 有紀 HIRAMATSU Y.
    • 東京女子医科大学東医療センター外科 Department of Surgery, Tokyo Women's Medical University Medical Center East
    • 吉松 和彦 YOSHIMATSU K.
    • 東京女子医科大学東医療センター外科 Department of Surgery, Tokyo Women's Medical University Medical Center East
    • 横溝 肇 YOKOMIZO H.
    • 東京女子医科大学東医療センター外科 Department of Surgery, Tokyo Women's Medical University Medical Center East
    • 藤本 崇司 HUJIMOTO T.
    • 東京女子医科大学東医療センター外科 Department of Surgery, Tokyo Women's Medical University Medical Center East
    • 梅原 有弘 UMEHARA A.
    • 東京女子医科大学東医療センター外科 Department of Surgery, Tokyo Women's Medical University Medical Center East
    • 大谷 泰介 OTANI T.
    • 東京女子医科大学東医療センター外科 Department of Surgery, Tokyo Women's Medical University Medical Center East
    • 松本 敦夫 MATSUMOTO A.
    • 東京女子医科大学東医療センター外科 Department of Surgery, Tokyo Women's Medical University Medical Center East
    • 大澤 岳史 OSAWA T.
    • 東京女子医科大学東医療センター外科 Department of Surgery, Tokyo Women's Medical University Medical Center East
    • 小川 健治 OGAWA K.
    • 東京女子医科大学東医療センター外科 Department of Surgery, Tokyo Women's Medical University Medical Center East

抄録

症例は75歳,男性.主訴は3カ月にわたる頻回の便意.左下腹部に約20cmの細長い弾性硬の腫瘤を触知し,注腸検査でS状結腸から上部直腸にかけて腸管の伸展不良と狭小化,鋸歯像を認めた.下部消化管内視鏡検査で同部位に粘膜不整のない全周性狭窄を,腹部CT検査で同部位の腸管壁の全周性狭窄と腸間膜の脂肪織濃度の著明な上昇を認めた.以上より腸間膜脂肪織炎を疑ったが,早期の症状改善を目的に手術を施行した.開腹所見ではS状結腸から上部直腸の腸管壁は著明に肥厚し,腸間膜も著明に肥厚,短縮しており,低位前方切除術を施行した.病理組織検査では漿膜下層脂肪織の広汎な壊死とfoamy cellsを含む組織球の反応性増殖を認め,腸間膜脂肪織炎と診断した.術後経過は良好で排便異常は改善し,術後第16病日に退院した.退院時再発の兆候はなかったが,数日後に急性心筋梗塞により死亡したためその後の観察は不能となった.<br> 本疾患は良性疾患であり保存的治療が原則であるが,病状が長期にわたり狭窄症状が強い場合,外科的切除も考慮すべきと考える.<br>

We herein report a case of mesenteric panniculitis of the large bowel successfully treated by surgery. A 74-year-old man was admitted for further examination of his chief complaint that he wished to defecate many times a day. At his lower left abdomen, an elastic hard tumor of approximately 20cm in size was palpable. Barium enema showed bad extension, stenosis and serrated appearance of the large bowel from the sigmoid colon to the upper rectum. Stenosis without mucosal dysplasia was observed by colonoscope. Computed tomography showed wall thickening at the same part of the large bowel and elevated density of mesenteric fat. Although he was suspected of having mesenteric panniculitis, laparotomy was performed to improve his complaint early. The operative finding was that the walls of the large bowel from the sigmoid to the upper rectum and the mesentery were extremely thickened and so low anterior resection was performed. Pathologically, his diagnosis was of having mesenteric panniculitis based on the findings of necrosis of the subserosal fat and the reactive histiocytosis including foamy cells. Postoperative course was not eventful and his defecation was improved. He was discharged on the 16th POD.<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(3), 119-122, 2008-03-01 

    The Japan Society of Coloproctology

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