AIDSによる播種性非定型抗酸菌感染症にて腸閉塞をきたした1手術例  [in Japanese] A Case of Small Bowel Obstruction due to Mycobacterium Avium Intracellulare Associated with the Acquired Immunodeficiency Syndrome  [in Japanese]

Search this Article

Author(s)

    • 井坂 直秀 ISAKA Naohide
    • 筑波メディカルセンター病院消化器外科 Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital
    • 山田 圭一 YAMADA Keiichi
    • 筑波メディカルセンター病院消化器外科 Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital
    • 稲川 智 INAGAWA Satoshi
    • 筑波メディカルセンター病院消化器外科 Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital
    • 阿竹 茂 ATAKE Shigeru
    • 筑波メディカルセンター病院消化器外科 Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital
    • 辻 勝久 TSUJI Katsuhisa
    • 筑波メディカルセンター病院消化器外科 Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital
    • 石川 詔雄 ISHIKAWA Akio
    • 筑波メディカルセンター病院消化器外科 Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital

Abstract

AIDSが誘因となった播種性非定型感染症にて腸閉塞をきたした1例を経験した.症例は48歳の男性.主訴は腹痛と嘔吐であった.開腹既往歴なし.1996年カリニ肺炎にてAIDS発症,その後サイトメガロ網膜炎,陰部ヘルペス,頸部リンパ節腫脹を伴う播種性非定型抗酸菌感染症を発症し当院外来にて加療中であった.2000年に左下腹部痛を主訴に当院を受診した.身体所見上左下腹部圧痛を認め,諸検査にて腸閉塞と診断され,入院した.入院3日後症状増悪し緊急開腹手術を施行した.開腹所見にて,横行結腸と癒着しarchを形成する上部空腸腸間膜リンパ節の著明な腫大を認め,空腸が陥入し腸閉塞となっていた.Archを解除し陥入する小腸を引き出したところ,腸管の色調は著明に改善を認めたために腸切除を行うことなく手術を終了した.術後25日目に退院したが,術後123日目にAIDSの増悪にて死亡した.AIDSが誘因となった腸閉塞は本邦でも今後増加する可能性があり,文献的考察を加え報告する.

A 48-year-old man with AIDS complicated by small bowel obstruction due to Mycobacterium avium intracellulare (MAI) was successfully treated in emergency surgery. Here, we report on the case. The man was diagnosed with AIDS based on a history, with a history of pneumocystis carinii in 1996 and was treated with antiretroviral drugs. He then came down with cytomegaloviral retinitis and disseminated MAI with cervical lymphadenopathy. When admitted in 2000, for left lower abdominal pain, he was found on physical examination to have tenderness localized to the left lower abdominal quadrant. Based on a diagnosis of small bowel obstruction, he was treated conservatively, but his symptoms of peritonitis worsened 3 days after admission, necessitating emergency laparotomy. Marked lymphadenopathy was found between the first and second jejunal arteries and an inflammatory adhesion had formed in the ligament toward the transverse colon, obstructing the small bowel. This was relieved by lysis of the adhesions. The postoperative course was uneventful and he discharged with good oral intake, but died 123 days after surgery due to progressive AIDS.

Journal

  • The Japanese journal of gastroenterological surgery

    The Japanese journal of gastroenterological surgery 36(2), 129-133, 2003-02-01

    The Japanese Society of Gastroenterological Surgery

References:  27

Cited by:  1

Codes

  • NII Article ID (NAID)
    110001294776
  • NII NACSIS-CAT ID (NCID)
    AN00192066
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03869768
  • Data Source
    CJP  CJPref  NII-ELS 
Page Top