INTESTINE Vol.19 No.2(2-3-4)

特集名 小腸の炎症
題名 各論 (3) その他の炎症性疾患 d. 放射線性小腸炎
発刊年月 2015年 03月
著者 永山 学 自治医科大学内科学講座消化器内科学部門
著者 矢野 智則 自治医科大学内科学講座消化器内科学部門
【 要旨 】 放射線性小腸炎は放射線治療によって生じる小腸障害で,放射線治療から発症までの期間により早期障害と晩期障害に分類される.早期障害は粘膜傷害により下痢や血便を呈し,放射線治療後には改善する.晩期障害は血管内血栓や間質の線維化により発症し,症状としては下痢や血便(OGIB),低栄養状態,腸管狭窄によるイレウスを呈し,治療に難渋する場合が多い.おもな検査として,造影CT検査では腸管壁肥厚や狭窄,口側拡張を認め,バルーン小腸内視鏡では毛細血管拡張や絨毛の発赤腫大や萎縮,びらん・潰瘍などを認める.バルーン小腸内視鏡は狭窄の鑑別診断や出血に対するアルゴンプラズマ焼灼術においてとくに有用である.
Theme Intestinal inflammation in small bowel
Title Small bowel radiation enteritis
Author Manabu Nagayama Department of Medicine, Division of Gastroenterology, Jichi Medical University
Author Tomonori Yano Department of Medicine, Division of Gastroenterology, Jichi Medical University
[ Summary ] Small bowel radiation enteritis is described as inflammation and damage to the intestinal mucosa caused by radiation treatment for malignant diseases. It is classified as being acute or chronic. Acute radiation enteritis manifests with diarrhea and bloody stools. It resolves soon after termination of radiation therapy. Chronic radiation enteritis is caused by obstruction of small vessels and mesenchymal fibrosis, which manifests not only with diarrhea and bleeding but also malnutrition and ileus, due to intestinal stenosis. These conditions are often refractory to medical therapy. Contrast-enhansed computed tomography reveals wall thickening, stenosis and distension on the oral side. Balloon-assisted endoscopy reveals telangiectasia, reddening and swelling of the villi, as well as erosion and ulceration. In addition, balloon-assisted endoscopy enables us to evaluate intestinal stenosis and hemostasis by argon plasma coagulation.