再燃治療中に2度の結腸穿孔を発症したWegener肉芽腫症の1例  [in Japanese] A Case Report of Colon Perforation Occurred Two Times during Treatment of Relapsed Wegener's Granulomatosis  [in Japanese]

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Author(s)

    • 北 健吾 KITA Kengo
    • 旭川医科大学外科学講座消化器病態外科学分野 Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical College
    • 小原 啓 OHARA Kei
    • 旭川医科大学外科学講座消化器病態外科学分野 Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical College
    • 長谷川 公治 HASEGAWA Kimiharu
    • 旭川医科大学外科学講座消化器病態外科学分野 Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical College
    • 千里 直之 CHISATO Naoyuki
    • 旭川医科大学外科学講座消化器病態外科学分野 Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical College
    • 谷口 雅彦 TANIGUCHI Masahiko
    • 旭川医科大学外科学講座消化器病態外科学分野 Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical College
    • 古川 博之 FURUKAWA Hiroyuki
    • 旭川医科大学外科学講座消化器病態外科学分野 Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical College

Abstract

症例は61歳の女性で15年前にWegener肉芽腫症と診断された.治療により寛解したが,60歳時,Wegener肉芽腫症に関連した頸椎の脊髄症を発症した.ステロイドパルス療法,シクロホスファミドの投与を受け一時改善したが,再燃したため入院した.入院50病日に強い腹痛を発症し,消化管穿孔を疑い開腹したところ横行結腸に穿孔を認めた.結腸を部分切除し人工肛門を造設した.術後14日目に再度消化管穿孔を発症し開腹した.人工肛門口側の結腸に穿孔を認めたため,右側結腸を切除,回腸人工肛門を造設した.穿孔部位の病理所見はいずれも血栓を伴う非特異的な虚血性潰瘍であった.Wegener肉芽腫症に関連した消化管病変はまれであり,病理組織学的検査で特徴的な血管炎が証明されないことも多いが,文献的考察によると消化管病変は血管炎が原因であり,治療中は消化管病変の合併も念頭に置き治療経過を観察するべきである.

A 61-year-old woman who had been diagnosed with Wegener's granulomatosis (WG) 15 years earlier, developed cervical myelopathy associated with WG. She received steroid pulse therapy and cyclphosphamide, and gained temporal remission. However, she was admitted to our hospital due to relapse. On the 50th day after admission, she developed severe abdominal pain. Laparotomy revealed a perforation of the transverse colon. Partial resection of the colon and colostomy were performed. On the 14th day after the surgery, she underwent operation again because of gastrointestinal perforation. At laparotomy perforation of the ascending colon was recognized, and right hemicolectomy and ileostomy were performed. Histological examinations of the resected specimens showed non-specific ischemic ulcers without vasculitis. Intestinal involvement in WG is rare and only a few cases have histological evidence of vasculitis at the site of affected areas. According to the literature, the intestinal involvement in WG can be caused by vasculitis. We must be aware of intestinal involvement of WG and carefully observe the patient during treatment.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 74(12), 3410-3415, 2013

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130004518586
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • Data Source
    J-STAGE 
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