蜂窩織炎性大腸炎の1例  [in Japanese] A CASE OF PHLEGMONOUS ENTEROCOLITIS  [in Japanese]

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Abstract

症例は61歳,男性.平成11年8月8日大量吐血し当院内科受診.食道静脈瘤破裂,肝硬変の診断にて内視鏡的静脈瘤結紮術を施行された.その後入院中であったが,平成11年8月27日朝より腹痛出現し,次第に増強しショックとなり,腹部CTにて盲腸から上行結腸にかけて高度の腸管浮腫を疑う著明な腸管の壁肥厚像を認めたため外科紹介となり緊急手術を施行した.上行結腸に虚血性変化を認めるも術中確定診断するには至らず,右結腸切除術を施行した.病理所見にて粘膜下層に著明な好中球のびまん性浸潤を認めることから蜂窩織炎性大腸炎と診断された.術後敗血症性ショック,肝,腎不全,播種性血管内凝固症候群となり集中的治療にもかかわらず術後16日目に死亡した.<br> 本疾患は非常に稀な疾患であるが,発症時すでに重篤で,予後不良である場合が多い.早期診断のためには,肝硬変患者における急性腹症に対して本疾患も念頭に置く必要があると思われる.

A 61-year-old man was seen at the department of internal medicine in our hospital because of massive hematemesis on August 8, 1999. With a diagnosis of rupture of an esophageal varix and liver cirrhosis, an endoscopic ligation of the varix was performed. While he was hospitalized thereafter, he had abdominal pain on August 27 which occurred in the morning and gradually progressed to shock state. An abdominal CT scan revealed prominent wall thickening of the intestine extending from the cecum to ascending colon, suggestive of high grade of intestinal edema. So the patient was referred to the department of surgery and underwent an emergency operation. At laparotomy, ischemic change on the ascending colon was confirmed, but no intraoperative definite diagnosis was made and a right colectomy was performed. Histopathologically remarkable submucosal diffuse infiltration of eosinophils was observed and phlegmonous enterocolitis was definitely diagnosed.The patient developed postoperative septicemic shock, liver and renal failure, and disseminated intravascular coagulation syndrome, and died on 16th day after the operation despite of intensive treatment. Although the diseases is a very rare entity, it often occurs in severe condition at the onset and resultantly has a poor prognosis. For early diagnosis, the disease must be kept acutely in mind for acute abdomen in patients with liver cirrhosis.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 62(4), 967-970, 2001-04-25

    Japan Surgical Association

References:  6

Cited by:  3

Codes

  • NII Article ID (NAID)
    10008389558
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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