脳出血に対する降圧療法中に発症した回盲部壊死型虚血性腸炎の1例

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We report a case of gangrenous ischemic enterocolitis associated with antihypertensive therapy for brain hemorrhage. A 65-year-old man was referred to us in April 2004 for brain hemorrhage with gait disorder. He had a history of untreated hypertension. When he visited our hospital, blood pressure was 212/107 mmHg. Antihypertensive therapy with continuous infusion of nicardipine chlorhydrate was started immediately after admission. Two days after the onset of brain hemorrhage, fever over 38°C, abdominal pain and signs of peritonitis appeared. Abdominal computed tomography showed thickening of the intestinal wall in the ileocecal region. Emergency surgery was performed. Ileocecal resection was done for the localizing necrosis in the cecum and terminal ileum. According to the macroscopic and histopathological findings of the resected specimen, the diagnosis of gangrenous ischemic enterocolitis was made. Abrupt decrease of blood pressure in the patient with arteriosclerosis might possibly promote ischemia in the intestinal wall. Therefore, attention should be paid to abdominal symptoms during antihypertensive therapy for brain hemorrhage.
日本大腸肛門病学会の論文