Nihon Daicho Komonbyo Gakkai Zasshi
Online ISSN : 1882-9619
Print ISSN : 0047-1801
ISSN-L : 0047-1801
Volume 34, Issue 6
Displaying 1-13 of 13 articles from this issue
  • M. Yamashiro
    1981 Volume 34 Issue 6 Pages 593-598
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    There is question about the cause of ischemic colitis to be truely ischemic or not. The majority of the transient ischemic colitis have non-occlusive pattern in vascular patency. They are speculated to be from functional occlusion of small mesenteric vessels.
    Clinically, abdominal pain, diarrhea and melena make the initial symptom complex. The left half of the colon is affected with high incidence and also with mild lesions, whereas the right half has low incidence, but high with severe lesions. Longitudinal ulcerative lesions may be one of the endoscopic chorocteristics of this disease.
    In the cases not having typical signs of ischemic colitis, they must be differentiated from the mimic lesions as follows; 1) infectious colitis, 2) pseudomembranous colitis, 3) radiation colitis, 4) diverticulosis, 5) vascular ectasia of the right colon, 6) acute extensive bowel ischemia due to SMA insufficiency. And obscure lesions not included in any lesion mentioned above should be reserved as a non-specific colitis.
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  • A. Iwashita, S. Kuroiwa, M. Enjoji, H. Watanabe
    1981 Volume 34 Issue 6 Pages 599-616
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Pathologic materials from nineteen patients with ischemic colitis were studied from a pathomorphologic viewpoint, and were compared with those from five patients with colitis occurring in the portion proximal to an obstructing carcinoma of the colon (obstructive colitis).
    In the acute phase of both diseases there were diffuse mucosal hemorrhage and irregular open ulcers, Ul- I and/or Ul-II, having tendency to longitudinal situation and to association with pseudomembrane. The histologic features consisted of fresh mucosal hemorrhage, degeneration and necrosis of glandular epithelium, open ulcers, and marked submu-cosal thickening due to prominent edema, hemorrhage, congestion and neutrophilic infiltration. In the chronic phase, both disease presented the lesion made up of one and/or three, long, longitudinal, linear or zonal ulcers, open or healed, along the teniae coli. The microscopic appearances in the chronic phase consisted of five main pictures as follows: 1) ulcers of Ul-II, 2) open ulcers floored with vascular granulation tissue, 3) prominent fibro-musculosis and fibrosis in the submucosa adjacent to the healing ulcers, 4) presence of many hemosiderin-laden macrophages scattered throughout the whole thickness of the colon, 5) a slight inflammatory infiltrate consisting mainly of lymphocytes and plasma cells. In addition, slight to severe fibromuscular intimal thickening of the small to medium-sized arteries situated in the serosa is recognized in four cases of ischemic colitis and two cases of bstrucotive colitis, respectively.
    Considering the pathomorphologic findings mentioned above, the both diseases may essentially be of identical nature and their causative factors resulting in the ischemic change of the colonic wall include arteriosclerotic changes, increased intraluminal pressure and spasm. In addition, the pathomorphogenesis of the characteristic ulcers in these conditions was briefly discussed.
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  • A. Kariya, M. Nishizawa
    1981 Volume 34 Issue 6 Pages 617-623
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Five cases of ischemic colitis were clinically followed and examined by double contrast method.
    Radiological changes of the disease at the acute phase consisted of narrowing of the lumen, "thumb-printing" and ragged "saw-tooth" irregularity.
    The next stage followed by acute phase was characterized by the longitudinal ulcer accompanied with multiple sacculation and one-sided stricture. Along with healing process of the longitudinal ulcer, sacculation and one-sided stricture became rapidly manifest within a month from the onset.
    Longitudinal ulcer formation was found in four of the five cases. The remaining one case had irregular-shaped, shallow and circumferential ulcers. And this case revealed bilateral stricutre and showed few sacculation.
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  • E. Kohda, Y. Sugino, K. Hiramatsu, K. Kumakura, N. Hibi, S. Kodaira, K ...
    1981 Volume 34 Issue 6 Pages 624-630
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    There were two groups: (1) Obstructions were noted in the major branches of the mesenteric artery and marginal artery; (2) No obstruction was seen in the major branches of the mesenteric artery and marginal artery. All of obstructive type were gangrene type by Marston. Angiographies demonstrate multiple obstructions that cause irreversible segmental ischemia, and they are useful for diagnosis of obstructive type of ischemic colitis. On the other hand, angiographies of non obstructive type were quite non specific. There were seen dilated vasa recta, capillary brush and early venous drainage in about 60%. Improvement of these findings were detected by pharmacoangiography using Prostagrandin F2α 100μg. One case, supposed to be in healing stage, demonstrate decreased number of vasa recta and poor visualization of mesenteric vein. It seems to be caused by fibrosis. Ischemic colitis caused by non obstructive infarction, collagen disease, and obstruction of venous side were also mentioned.
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  • K. Nagasako, K. Hasegawa, T. Taniguchi, B. Ri
    1981 Volume 34 Issue 6 Pages 631-639
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Six cases of acute ischemic colitis (IC) were observed colonoscopically. All of them had acute onset with rectal bleeding and abdominal pain. Endoscopic picture was those of acute hemorrhagic segmental colitis. Any manifestation of acute colitis is possible in IC, so that endoscopy is sufficient in diagnocis of IC when acute segmental lesion is found in cases with typical clinical features. Five cases were presented:
    1) typical IC, 2) segmental colitis with multiple discrete ulcers, 3) segmental colitis in which ulcers remained for more than months. 4) colitis in which the differentiation between IC and ulcerative colitis was difficult 5) Colitis in which the differentiation between IC and antibiotic-associated colitis was difficult.
    Angiographic demonstration of vascular abnormality is often difficult. Therefore IC is usually diagnosed without angiography. The clinical diagnosis is as follows.
    (1) Definite cases are equipped the following four conditions
    i) decrease in intestinal blood flow (e.g. elder person with cardiovascular con-ditions)
    ii) acute onset with rectal bleeding and abdominal pain
    iii) acute hemorrhagic segmental colitis
    iv) no history of antibiotics administration, no pathogenic bacilli shown in stool culture.
    (2) Probable cases lack one of above items (i-iv)
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  • Y. Sakai
    1981 Volume 34 Issue 6 Pages 640-645
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    It is sometimes quite difficult to diagnose ischemic colitis because there are many lesions which reveal similar findings clinically, radiologically, and endoscopically. Definite ischemia and inflammation of the bowel wall were occasionally demonstrated so that various manifestations are shown according to the period from the onset of attack. Although some lesions are clearly due to ischmia, such as obstructive colitis and irradiation proctocolitis, they are given different clinical entity because of possibly different therapeutic methods. Therefore, ischemic colitis should be ruled out from some fundamental vascular pathologies as shown in Table 1.
    According to the phase of ischemic colitis, differential diagnosis has to be performed. Patient's history, complaints, physical findings, laboratory data would suggest the possibility of this lesion rather than examination results. In endoscopical point of view, differential diagnosis should be performed according to the prominent finding and surrounding changes of the diseased segments as shown in Table 2. Angiography is occasionally helpful and histopathological study of biopsy, specimens is not specific to mke the diagnosis. Therefore, serial and repeated examinations are recommended for the differential diagnosis from soon after the initial episode to inactive phase.
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  • N. Ishiguro, S. Tsuchiya, T. Fukushima
    1981 Volume 34 Issue 6 Pages 646-649
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    The management of the three types of ischemic colitis is described. Transient form is treated conservatively by nothing per os, intravenous fluid, antibiotics, etc. under observation with colonoscopy and barium enema study. Stricturing form can be treated by one-stage resection and anastomosis. Gangrenous from requires an emergency operation for excision of the necrotic intestine. Construction of a proximal and distal colostomy is preferable to anastomosing the divided ends of intestine. This greatly reduces the operating time and would be safer. But, provided care is taken to ensure complete clearance of the ischemic intestine and operation is performed before perforation, primary anastomosis can be performed safely. Prognosis of patients with ischemic colitis without intestinal gangrene seems to be good, but that of patients with gangrenous form is poor. Information on recurrences has not yet been published.
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  • M. Fujioka
    1981 Volume 34 Issue 6 Pages 650-659
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Manometric and radiologic studies were carried out in 15 patients who underwent low anterior resection for carcinoma of the rectum, or the sigmoid colon. Twenty-four normal adults were also subjected to the studies as control.
    Most of the postoperative patients suffered from frequent bowel movements and occasional soiling within 4 to 6 months after the operation, but all the patients achieved good control of bowel movements by the sixth postperative month.
    Manometric and radiologic studies in these patients disclosed that : 1) There was no significant changes of resting pressure profile, but decreased basal rhythmic contraction of the anal canal, in the postoperative patients. 2) Normal recto-anal reflex was present in all the postoperative patients. Low rectal compliance was characteristic of the postoperative patients. Decrease of rectal compliance was significant in those within 6 months after the operation. 4) Rectal distending. volume initiating recto-anal reflex or desire to defecate was significantly small in the postoperative patients, whereas there was no significant difference of rectal distending pressure initiating recto-anal reflex or desire to defecate between normal adults and the postoperative patients. 5) There was no significant difference of the rectal area on the lateral view of barium enema films between the early postoperative patients with disturbed bowel control and those who established good control of bowel movements.
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  • K. Kotake, S. Kodaira, T. Teramoto, M. Ikoma, S. Ii, J. Miyata, T. Kat ...
    1981 Volume 34 Issue 6 Pages 660-668
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    For the past ten years, twenty-four patients with massive lower gastrointestinal bleeding (M.L.G.I.B.) have been treated at Keio University Hospital. Although, M.L.G.I.B. is less common, compared with upper G.I. bleeding, it is often associated with severe underlying disease which make the prognosis poor. From the analysis of our cases, we described here the diagnosis and management of M.L.G.I.B..
    We consider both proctosigmoidoscopy and angiography are the most useful techniques for localizing the bleeding sites, and subsequently hemostasis using tamponade, direct liga-ture of blood vessel and transcatheter hemostasis can be employed. Bleeding sites could be detectable with proctosigmoidoscopy in thirteen cases. In seven of eight cases the bleeding sites were identified by angiography, performed in active hemorrhagic period. Colonoscopy and barium enema had limited roles in diagnostic evaluation for M.L.G.I.B. because of unprepared bowels.
    Most cases of M.L.G.I.B. required surgical operation eventually, and in thirteen of our cases surgical intervention was performed. Elective surgery is a choice, if possible, and emergent surgery is indicated only when the diagnosis is made and bleeding cannot be controlled by non-operative means.
    Seventeen patients had some disorders, including blood dyscrasia, cerebral hemorrhage, collagen disease, malignancy, portal hypertension etc., and we must be reminded that a patient with M.L.G.I.B. might have a serious disease.
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  • A. Kitano, K. Kobayashi, H. Oshiumi, K. Ookawa, S. Oka, Y. Tanaka, S. ...
    1981 Volume 34 Issue 6 Pages 669-675
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    A 31-years old woman was admitted on October, 1979. She had aphthous stomatitis, skin eruption, ulcer of the vagina. She developed progressive abdominal pain and massive melena occurring abruptly two month before admission.
    Barium enema revealed multiple ulcers with covergence of mucosal folds in the ileum.
    Colonoscopically, deep ulcers were observed in the terminal ileum. It was covered with yellow fur and had the convergence of mucosal folds.
    Intestinal Behcet disease was suspected, but verious medication was ineffective.
    The patient underwent ileocaecal resection and the resected specimen demonstrated multiple sharply-demarcated ulcers with undermined margins. Histologically, it was a non-specific ulcer.
    Two months later, she had occasionally developed abdominal pain and melena. Multiple punched-out ulcers were observed on the oral side of the anastomosis in the ileum by barium enema and endoscopical examination.
    For recurrent intestinal Behcet disease, the patient underwent medication (SASP, prednisolone). Therapeutic response to that drugs was satisfactory and ulcers healed colonoscopically. Currently she is doing well without any obvious symptoms of intestinal Behcet disease.
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  • Y. Mori, A. Nagahama, I. Takehisa, H. Furuya, F. Fukushima, T. Kidokor ...
    1981 Volume 34 Issue 6 Pages 676-679
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Diverticular disease of the colon is very popular in Europe and United States and it is not unusual to see fistula-complicating diverticulitis cases in the countries. But it is rare in Japan and only 7 cases have been reported, Which consist of 3 sigmoid-vesical, 2 colo-cutaneus, 2 colo-ileal fistulas.
    We experienced 2 cases of fistula-complicating diverticulitis of the sigmoid colon. One is sigmoid-ileal and the other is sigmoidcutaneus fistula and both the cases were cured by operative procedure. Recently, with the chande of Japanese life and diet to those similar to European style, various diseases of the colon have increased. Originally, diverticular disease of the colon was recognized in right side of the colon, but recently it is found more in left side of the colon and we suspect fistla-complicating diverticular disease of the colon will increase in future.
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  • 1981 Volume 34 Issue 6 Pages 680-696,699
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
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  • 1981 Volume 34 Issue 6 Pages 720-727
    Published: 1981
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
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