胃と腸58巻6号

2023年06月発行

早期胃癌研究会症例

idiopathic myointimal hyperplasia of mesenteric veinsの1例

著者： 郷内貴弘¹ 鳥谷洋右¹ 川崎啓祐² 梁井俊一¹ 上杉憲幸³ 菅井有³ 松本主之¹

所属機関： ¹岩手医科大学医学部内科学講座消化器内科分野 ²九州大学大学院医学研究院病態機能内科学消化器研究室 ³岩手医科大学医学部病理診断学講座

ページ範囲：P.823 - P.831

要旨●患者は60歳代，男性．腹部膨満感と粘液便を主訴に前医を受診し，腸間膜脂肪織炎の診断でステロイド治療を受けるも改善なく経過したため，6か月後に当科へ紹介され受診となった．注腸X線造影検査では下行結腸からS状結腸にかけて長い管状狭窄と拡張不良がみられ，遠位大腸に拇指圧痕像を伴っていた．下部消化管内視鏡検査では下行結腸からS状結腸を中心に全周性区域性の潰瘍と内腔の狭小化を認めた．以上の画像所見と緩徐な臨床経過から，静脈性の虚血性腸病変を考え，腹腔鏡補助下Hartmann手術および横行結腸人工肛門造設術を行った．切除標本の病理組織学的所見では，上皮欠損部に一致する粘膜下層および漿膜下の静脈壁に著明な肥厚と内腔の閉塞がみられたことから，IMHMV（idiopathic myointimal hyperplasia of mesenteric veins）と診断した．

参考文献

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