治療経過中に上腸間膜静脈血栓症を併発した悪性リンパ腫,および赤芽球癆症例  [in Japanese] Superior mesenteric venous thrombosis during treatment of malignant lymphoma and of pure red cell aplasia  [in Japanese]

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Abstract

腸間膜静脈血栓症(MVT)は腸管虚血の原因の一つであるが,その頻度は非常に低い。われわれは,非Hodgkinリンパ腫および赤芽球癆に合併した上腸間膜静脈血栓症例を経験した。ともにアンチトロンビン欠損症などの過凝固状態をもたらす異常は認めなかった。前者では,化学療法直後の発症であることより,抗癌剤による血管内皮障害とB型慢性肝炎の悪化による門脈圧亢進がMVTの発症に関与したと推測される。また後者では,長期間のステロイド製剤の内服による過凝固状態が誘因としてあげられる。MVTの症状は,間歇的な腹痛や腹部膨満感,まれに血性下痢などの非特異的な腹部症状が主体で病初期には看過されることが多い。幸い予後は比較的良好であるが,これは早期発見と適切な外科的処置を行うことが前提となる。臨床的に腸間膜静脈血栓症が疑われた場合,可及的早期に腹部CT等で血栓の有無を確認し,患部の外科的切除と抗凝固療法の開始を行うことが肝要である。

Mesenteric vein thrombosis is an uncommon type of intestinal ischemia that can be associated with significant mortality if its diagnosis is delayed. We experienced two patients with hematological disorders-non-Hodgkin's lymphoma (NHL) and pure red cell aplasia (PRCA)-who developed superior mesenteric vein (SMV) thrombosis during treatment. Neither of the patients had underlying disorders of the anticoagulant system that might have produced a hypercoagulable state. The first patient developed SMV thrombosis immediately after chemotherapy for NHL. This patient also had portal hypertension due to chronic hepatitis B. Direct injury to endothelial cells by the anti-cancer drugs and alteration of blood flow were the probable causes of the SMV thrombosis. The second patient with PRCA had regularly taken prednisolone, and this had induced a hypercoagulable state. The clinical symptoms of SMV thrombosis are usually non-specific, and in our patients vague, crampy abdominal pain without bloody diarrhea was the only complaint. Abdominal CT scan under a clinical suspicion of SMV thrombosis revealed the thrombi in the SMV. Urgent surgical resection of the infarcted bowel and immediate postoperative anticoagulation resulted in a favorable outcome. Clinicians should be aware of the vague symptoms of SMV thrombosis, as early diagnosis and urgent therapy are essential to prevent a fatal outcome.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 43(1), 17-22, 2002-01-30

    The Japanese Society of Hematology

References:  12

Codes

  • NII Article ID (NAID)
    10008355734
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    04851439
  • NDL Article ID
    6293708
  • NDL Source Classification
    ZS21(科学技術--医学--内科学)
  • NDL Call No.
    Z19-295
  • Data Source
    CJP  NDL  J-STAGE 
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