Carcinoma of the Sigmoid Colon Complicating Ulcerative Colitis: Report of a Case

患者は42歳女性.13年前より潰瘍性大腸炎のため他院にて保存的治療を続けていた.2週間前より腹部膨満,嘔吐,腹痛などのイレウス症状と下痢が出現したため来院した.来院時の注腸造影ではS状結腸に高度の狭窄を認めたが,肛門側粘膜には隆起性病変は描出されなかった.内視鏡検査では狭窄部と内視鏡が通過せず,肛門側粘膜は平坦で隆起性病変,活動性炎症は認めなかった.生検で癌は認められず,検査所見よりS状結腸癌の存在を疑っていたところイレウス症状の増悪を認めたため手術を施行した.手術所見は大動脈周囲リンパ節に転移を伴う4型のS状結腸癌で,S状結腸切除術,リンパ節廓清を施行した.組織学的にはびまん性浸潤を示す印環細胞癌を主体とした腺癌で,周囲粘膜にdysplasiaを認めた.本邦における長期経過を有する潰瘍性大腸炎癌化報告例は欧米に比して未だ少ない.その点について若干の文献的考察を加え,報告した.

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