抄録
A 42-year-old man visited our department chiefly complaining of abdominal pain, diarrhea and hematochezia. Colonoscopy (CS) led to a diagnosis of ischemic colitis (IC) . Although the patient was monitored, he showed recurrence of symptoms three months later. The man underwent colonoscopy again at a local hospital, which revealed longitudinal ulcers and raised a suspicion of Crohn’s disease. He was started on PSL at a dose of 30 mg/day, but as the symptoms did not improve, this was increased to 60 mg/day. The man was then admitted to our department for treatment. After admission, he was fasted and received antibiotics─achieving symptomatic relief. CS and abdominal CT were performed to determine the effect of PSL therapy. Mucosal thickening had worsened, the sigmoid mucosa appeared yellow and white, and the intestinal lumen had narrowed. CS findings were again suggestive of IC and subsequently symptoms improved. However, the pa-tient re-presented with signs of disseminated intravascular coagulation (DIC) and underwent Hartmann’s procedure in the Department of Surgery, which rapidly improved the signs of DIC. It was difficult to diagnose IC in this relatively young man, who developed recurrence in a short period of time, had the above-described CS findings, and experienced improvements in abdominal symptoms after increasing PSL dose. However, his physical state was associated with conditions of chronic circulatory insufficiency, with vascular factors such as hypertension and dialysis. Pathologically, marked microvascular blood flow disturbances were identified, suggesting that local intestinal necrosis due to microcircular vascular insufficiency occurred. It is possible that the patient had microvascular blood flow disturbance, and required close monitoring.
