臨牀消化器内科 Vol.34 No.1(2-2)


特集名 血流障害と消化管疾患
題名 虚血性腸病変 (2) 虚血性小腸炎
発刊年月 2019年 01月
著者 梅野 淳嗣 九州大学大学院病態機能内科学
著者 平野 敦士 九州大学大学院病態機能内科学
著者 鳥巣 剛弘 九州大学大学院病態機能内科学
著者 江﨑 幹宏 佐賀大学医学部附属病院光学医療診療部
【 要旨 】 虚血性小腸炎は,血流障害によって小腸に限局した虚血性病変が生じる疾患の総称であり,原因が不明な特発性虚血性小腸炎と原因が明らかな続発性虚血性小腸炎に大別される.高血圧,虚血性心疾患や糖尿病などの基礎疾患を有する中高年の男性に好発する.腹痛の原因疾患としてはまれであるが,病歴から本症が疑われる場合には,腹部造影CT検査に加え,小腸X線造影検査や内視鏡検査などの消化管検査を併用し総合的に診断する.初期には腸管安静,輸液などの保存的加療が行われるが,高度狭窄をきたし通過障害が改善しない場合,外科的切除術が必要となる.
Theme Gastrointestinal Disease Due to Blood Flow Damage
Title Ischemic Enteritis
Author Junji Umeno Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
Author Atsushi Hirano Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
Author Takehiro Torisu Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
Author Motohiro Esaki Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospitaly
[ Summary ] Ischemic enteritis is a disease entity that includes heterogeneous diseases that cause small bowel lesions secondary to insufficient blood flow. It is usually classified as the idiopathic and the secondary types, and the latter variety is associated with various diseases. Notably, the idiopathic type is rare. Ischemic enteritis usually affects middle-aged or elderly men with comorbidities including hypertension, ischemic heart disease, and diabetes mellitus. Abdominal computed tomography, small bowel radiography, and enteroscopy with biopsy are useful diagnostic tools in patients with this condition. Patients with confirmed emboli should be treated with fluid resuscitation; however, bowel rest with fluid replacement is a standard therapy in patients with idiopathic ischemic enteritis. Surgical treatment is required in patients who develop severe irreversible stenosis.
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