横行結腸穿孔をきたした全身性硬化症の1例 [in Japanese] A CASE OF SYSTEMIC SCLEROSIS WITH PERFORATION OF THE TRANSVERSE COLON [in Japanese]
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症例は61歳女性.全身性硬化症(SSc)にて経過観察中であったが,突然の上腹部痛と約2カ月間続く便秘を訴え当院受診.腹部CT検査にて腹腔内遊離ガス像を認め,消化管穿孔と診断し緊急手術を施行した.横行結腸壁が腸間膜付着部対側で3カ所半球状に膨隆し,その口側横行結腸には穿孔と網嚢内への糞便の流出を認めた.膨隆部を含めて横行結腸穿孔部を切除し,上行結腸にて人工肛門を造設した.横行結腸壁の膨隆はSScに特徴的な広茎憩室, wide-mouthed diverticuli内に詰まった球形糞塊によるもので,腸閉塞をきたし穿孔に至った原因となっていた.糞塊の形成にはSScによる蠕動運動障害の関与が示唆された. SScにおける大腸穿孔は稀であるが,重篤な合併症として重要である. SSc患者の診療に際しては系統的な消化管病変の評価と安定した排便習慣の確立が重要と思われる.
A 61-year-old woman who had been followed up for systemic sclerosis came to our hospital complaining of severe upper abdominal pain and constipation that had persisted for about two months. An abdominal CT scan revealed intra-abdominal free air, and emergency laparotomy was performed for a diagnosis of gastrointestinal perforation. Three bulges (wide-mouthed diverticuli) were found on the antimesenteric border of the transverse colon, and the colon was perforated proximal to the site of these diverticuli. Feces had escaped through the perforation into the omental bursa, and partial resection of the transverse colon and a colostomy were performed. The wide-mouthed diverticuli which are pathognomonic of SSc, contained hard round fecal masses, and fecal impaction was thought to be a cause of the intestinal obstruction and perforation. Hypoperistalsis seems to have been related to the formation of hard round feces. The patient's postoperative course was uneventful, and she was discharged on the 25th day. Colorectal perforation is rare, but important because of its seriousness. Evaluation of gastrointestinal manifestations and maintaining regular bowel movements are mandatory during clinical treatment of patients with this disease.
- Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 62(10), 2435-2438, 2001-10-25
Japan Surgical Association