Search

急性期虚血性小腸炎の手術症例を経験したので報告する.症例は61歳,男性.腹痛,嘔吐を主訴に当科紹介入院となった.腹部CT上,絞扼性イレウスが疑われたため緊急手術を行った.開腹時,絞扼の所見はなかったが,小腸の虚血性変化を認めたため小腸部分切除術を行った.一般的に急性期虚血性小腸炎は保存的加療が行われるが,特徴的所見に乏しいため診断が難しく,特に自験例のような絞扼が疑われる症例に対しては緊急手術の適応であると考えられた.

症例は33歳,女性, 21歳の時,他施設でCrohn病と診断され,緩解と再燃を繰り返していた. 31歳時, Crohn病の増悪に伴う下行結腸穿孔にて手術施行.これまで,痔瘻の既往は認めていない.今回,再度腸穿孔を認め,回腸に人工肛門を造設した.入院中に肛門痛が出現し, Crohn病の肛門病変を疑ったが明らかな膿瘍,痔瘻は認めなかった.その後も肛門痛持続するため,肛門狭窄部の生検を行ったところ,粘液癌と診断され直腸切断術を施行した.肉眼的には肛門管主体に5型の腫瘍を認め,組織学的には粘液癌や高分化腺癌が混在していた.発症から13年目に肛門管癌を合併した小腸大腸型Crohn病の1例を報告した.また, Crohn病に合併した大腸癌の本邦報告49例についての集計し検討を加えた.

We experienced a case of secondary amyloidosis causing intestinal obstruction. An 81-year-old woman, having an underlying disease of rheumatoid arthritis, was admitted to the hospiatal because of bloody diarrhea, vomiting, abdominal pain and fever elevation. An emergency laparotomy was carried out under a diagnosis of intestinal obstruction due to ischemic enteritis, and extended dilatation and multiple ulcers of the ileum were found. Partial resection of the ileum was performed. Histopathological examination revealed AA amyloidosis. Emergency surgery for amyloidosis of the gastrointestinal tract is rare, with only 18 reported cases in Japan so far. At operation, most patients with amyloidosis already have deposited amyloid proteins to multiple organs, so that their prognoses are very poor.

A case of intussusception caused by a cancer of the sigmoid colon is reported with a review of the literature. An 86-year-old woman was admitted to the hospital because of tenesmus and diarrhea. A tumor was palpated by digital examination. The patient was diagnosed as intussusception due to a sigmoid colon cancer by abdominal computed tomography, colon fiber, pelvic magnetic resonance imaging (MRI), and gastrographin enema. Upon laparotomy the sigmoid colon headed by the tumor invaginated into the rectum by about 10cm in length causing intussusception. The tumor of the sigmoid colon was MP, N0, P0, H0, M(-), and in Stage I. Hartmann operation with D, lymph nodes dissection was performed. Microscopically it was well differentiated adenocarcinoma, ss, n(-), ly1, v1. Adult intussusception is a compartively rare disease. But it matters whether intussusception is associated with cancer or not and diagnostic imaging, especially MRI is useful for its diagnosis. Pelvic MRI can show any cross-section and is very useful for visualizing intussusception caused by a tumor and for estimating invasive depth of the tumor like in our case.

Recently colorectal carcinomas have been increasingly reported, multiple carcinomas of the colon and rectum are not rare, and the hereditary factor seems to be involved in the etiology of such multiple occurrence. Thirty-seven cases of multiple colorectal cancers experienced at the department in a recent 14-year period were clinicopathologically studied. Of these 37 patients, seven patients (15 lesions) had a family history of colorectal cancer within the first degree relatives (positive group) and the remaining 30 patients (65 lesions) had no family history (negative group). Patients in the positive group were younger than those in the negative group. Carcinomas of the positive group were located in more prpximal colon than those of the negative group. Histological examination revealed that most of the first lesions in the positive group were moderately differentiated adenocarcinomas while the second lesions were commonly well differentiated adenocarcinomas. Presence of associated adenomatous polyps was more common in the negative group than in the single carcinomas. The cumulative 5-year survival rate was 62.5% in the positive group and 42.0% in the negative group. All patients in the positive group satisfied the diagnosis criteria of HNPCC (hereditary nonpolyposis colorectal cancer), but the negative group may include initiator of HNPCC.