右下腹部痛(Right Lower Quadrant Pain)シリーズ8 RESIDENT COURSE 解答 【症例 RR 38】

右側結腸憩室炎.Diverticulitis of right colon.






盲腸は図11までで,回腸末端(TI)は図10から始まる.右側結腸は粘膜下浮腫で壁肥厚を呈し,図7と図8で複数の憩室を認め(↑),責任病変である図10の↑周囲に腸管外脂肪組織の濃度上昇を呈しており(図7〜図10:△)憩室炎である.壁肥厚する腸管の長さは15cm以内にとどまることが多いが,この例では15cmを少々超えている.






文献考察:我が国で右側結腸憩室は増加しつつある
Dis Colon Rectum. 2000 Oct;43(10):1383-9.
Recent trends in diverticulosis of the right colon in Japan: retrospective review in a regional hospital.
Miura S, Kodaira S, Shatari T, Nishioka M, Hosoda Y, Hisa TK.

PURPOSE: Diverticulosis of the right colon has been increasing in the Far East; however, a considerable proportion of these patients includes cases of solitary right-sided diverticular disease. This study aimed to determine whether the incidence of such solitary diverticula (defined as 1 or 2 diverticula in this study) and multiple (3 or more) diverticula of the right colon is increasing in Japan. METHODS: A total of 13,947 consecutive barium enema examinations, performed in the period from 1982 to 1997, were reviewed. Changes in the frequency (detection rate) and number of diverticula across time and with aging of three types of diverticula, right-sided, left-sided, and bilateral, were investigated, with special interest in those patients with one or two diverticula of the right colon. RESULTS: Right-sided and bilateral diverticula have increased in frequency across time; however, left-sided diverticula have not. Patients with one or two diverticula in the right colon of right-sided disease, unexpectedly, have increased across time in both genders, and patients with three or more diverticula in the right colon of right-sided disease have shown an increase in males. The number of diverticula of the right colon showed no increase across time or with aging. CONCLUSIONS: Diverticulosis of the right colon, both solitary and multiple, has been increasing steadily in Japan; therefore, diverticulitis and bleeding diverticula of the right colon may continue to increase. Diverticula of the right colon might be an acquired disease and self-limiting in development, because the frequency did not increase substantially in the elderly and because the number changed little across time and with aging.PMID: 11052515
  【参照症例】   1. 右下腹部痛シリーズ2 【症例 RR 6,7】

 【 ←前の問題 】   【 次の問題→ 】  【 このシリーズの問題一覧に戻る 】 【 演習問題一覧に戻る 】