大腸内視鏡操作が誘因と考えられる虚血性大腸炎の1例

概要

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A 84-year-old man suffering from aspiration pneumonia on pulumonary emphysema who had taken home oxygen therapy was admitted to our hospital. Because of positive result of the fecal occult blood test on admission, colonoscopy was performed without oxygen administration after the cure of the pneumonia. A sigmoid colon polyp of 10 mm in diameter (ISP type) was easily removed in a short time by the method of saline injection in submucosal layer. On that night a light melena was found without abdominal pain, so sigmoidscopy was performed in the next day. Longitudinal mucosal redness and erosions were found in the sigmoid colon from the anal side of the resected site. Pathological findings of biopsy specimen were compatible with those of ischemic colitis. There were no pathogenic bacterium from liquid stool at sigmoidscopy and no recent history of antibiotics use. Endoscopic findings were improved one week later only by fasting and parenteral nutrition. We think this ischemic colitis was caused by circulatory disturbance due to temporal pressure and stretch of the colon in the colonoscopy procedure. In case colonoscopy or polypectomy is performed to a patient with hypoxemia, we think oxygen supplementation should be considered with extra care to explosion.
Japan Gastroenterological Endoscopy Society Kanto Chapterの論文