原因不明の虚血性小腸狭窄症の1例

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  • A CASE OF IDIOPATHIC ISCHEMIC STENOSIS OF THE SMALL INTESTINE

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This paper describes an idiopathically developed ischemic stenosis of the small intestine in a 71-year-old man. There were previous histories of hypertension and cholelithiasis which had not been treated, and he had undergone an appendectomy about 40 years before. This time the patient was seen at the hospital because of epigastric pain and was admitted with a diagnosis of intestinal obstruction. He had nausea and abdominal distention which repeatedly apperared and diappeared for about 10 days before admission. As imaging methods including abdominal ultrasonography revealed an association of a hepatic tumor, intestinal obstruction due to a malignant gastrointestinal tumor with hepatic metastasis was suspected. Further close examination disclosed that the hepatic tumor was hemangioma. Intestinal fluoroscopy visualized a localized circumferential stenosis in the ileum. Upon laparotomy, a wholecircumferential stenosis about 350cm distant from the Treitz ligament was confirmed, and a partial resection of the small intestine was carried out. Based on macroscopic and microscopic findings of the resected specimen as well as the clinical symptomas and underlying diseases, the diagnosis of ischemic stenosis of the small intestine was made.<br> This is a rare entity, however, we should entertain it as a probable diagnosis for a patient with intestinal obstruction who has underlying diseases such as cardiovascular diseases and diabetes mellitus, or some risk factors affecting the circuration of the intestine.

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