図３〜図６で回腸末端（TI）と一部の小腸（SB）が拡張している．その原因は図２〜図４の，高濃度に造影される，壁肥厚を示す病変（↑）であるが，Crohn病，結核，lymphoma，adenocarcinomaなどを疑う．A：上行結腸，C：盲腸

図１９〜図２２で骨盤腔内に腹水がある（※）．図９の１から回腸末端（TI）が始まるが，図１０で高濃度に造影される病変は残存し（▲），図１１の３から口側は，図１８の１６まで約22cmにわたり均一なwater densityの粘膜下浮腫による壁肥厚を呈している．図１０の高濃度の病変に急性腸炎を合併したと診断した．A：上行結腸，C：盲腸．その後再度腸閉塞症状が出現し，NGチューブを挿入し5日間経過観察したが改善しないので手術を施行した．回腸末端で閉塞病変を認め切除したら潰瘍性病変を示した（図A：△）．病理：悪性腫瘍，結核やCrohn病の所見はなく非特異性単純潰瘍である．急性腸炎の所見は回腸潰瘍に細菌性感染を合併したものか，または閉塞性腸炎（下記文献参照）と思われた．

参考文献：閉塞性腸炎（obstructive enreritis）
１）Surg Today. 2003;33(3):205-8.
Obstructive ileitis secondary to colon cancer: report of a case.
Matsuda T, Taniguchi F, Tsuda T, Aikawa I.

We report a case of obstructive ileitis (OI) secondary to colon cancer. A 62-year-old man was hospitalized for abdominal pain and a feeling of fullness. Examinations revealed a mechanical ileus caused by an obstructing carcinomatous lesion of the cecum. He underwent laparotomy on the tenth hospital day, and a right hemicolectomy was carried out with resection of the distended and edematous ileum. The histopathologic diagnosis was adenocarcinoma in the cecum involving the ileocecal valve and nonspecific inflammatory change of the ileum, with mucosal necrosis and neutrophilic infiltration involving the subserosal layer. His postoperative course was uneventful. OI does not always show similar histological features to obstructive colitis; however, they are both important types of obstructing lesions, and their possibility must be kept in mind during colorectal cancer surgery.
PMID: 12658388

２）Histopathology. 1994 Jul;25(1):57-64.
Obstructive enterocolitis: a clinico-pathological discussion.
Levine TS, Price AB.

Obstructive colitis is a condition that is not widely appreciated by pathologists. It is defined as an ulcero-inflammatory lesion(s) proximal to a colonic obstruction from which it is separated by a variable length of normal mucosa. Five cases are described which illustrate the clinico-pathological spectrum of the condition. All presented surgically as acute intestinal obstruction, secondary to adenocarcinoma in four cases and a diverticular stricture in one case. Pathologically, the severity of colitis ranged from a single discrete ulcer to an extensive area of fulminant colitis indistinguishable from colitis indeterminate. Furthermore, two cases represented 'obstructive enteritis', a variant of obstructive disease not previously reported. Microscopically, all cases were characterized by distinctive areas of localized ulceration and active inflammation, the features of which were quite unlike those of Crohn's disease or ischaemia, separated by islands of normal mucosa. The role of mural hypoperfusion and secondary localized ischaemia in the pathogenesis of this disorder is discussed. It is suggested that colitis indeterminate represents the final common pathological pathway of the intestine to a wide range of initial insults, be they obstructive or inflammatory.PMID: 7959646