| 特集名 | 下部消化管の出血性病変 | |
|---|---|---|
| 題名 | 虚血性大腸炎 | |
| 発刊年月 | 1997年 01月 | |
| 著者 | 山本 哲久 | 防衛医科大学校第一外科 |
| 著者 | 玉熊 正悦 | 防衛医科大学校第一外科 |
| 【 要旨 】 | 虚血性大腸炎の一過性型,壊死型,狭窄型のそれぞれについて,「出血」に注目し臨床像を述べ,自験例のうちから典型的な内視鏡像,治療経過を提示した.狭窄型を除いて,急激な腹痛と下血による発症が特徴的で,下血の仕方は,下痢であったものが出血を伴う形が多い.一過性型と壊死型の鑑別には,出血よりも圧痛や腹膜刺激症状の推移が重要で,発症当初から強度で持続性の腹痛や腹膜刺激症状を有する患者は,壊死型を疑い一刻も早く外科医にコンサルタントする必要がある.一過性型の虚血性大腸炎と,抗生物質起因性出血性大腸炎は,臨床症状や画像のみでは鑑別が困難なことが多く,薬剤についての問診情報が重要となる. | |
| Theme | Lower Gastrointestinal Bleeding | |
|---|---|---|
| Title | Ischemic Colitis | |
| Author | Tetsuhisa Yamamoto | 1st Department of Surgery, National Defense Medical College |
| Author | Shoetsu Tamakuma | 1st Department of Surgery, National Defense Medical College |
| [ Summary ] | This article reviews the clinical features of ischemic colitis with special referencc to rectal bleeding and differential diagnosis from the hemorrhagic colitis associated with antibiotics.We identified 21 patients with ischemic colitis over a 17-year period: 13 with the transient form; 5 with the gangrenous form; 3 with the stricture form. Surgical procedures were performed on the 8 patients with the gangrenous or stricture form. The clinical hallmarks were an acute onset of abdominal pain and rectal bleeding. Barium enema examination and colonoscopy revealed longitudinal ulcers and edema involving the left side of the colon in some patients with the transient form. These features were then compared with those of hemorrhagic colitis associated with antibiotics. Although the clinical symptoms and the initial radiographic or endoscopic findings were similar in the two diseases , a history of antibiotic administration and the site of involvement may facilitate diagnosis : the transient form of ischemic colitis usually involves the left side of the colon, while hemorrhagic colitis affects mainly the transverse colon. | |