内視鏡的に急性期および治癒期を観察し得た腸管出血性大腸菌O157 : H7による出血性腸炎の1例

Abstract

A 49-year-old woman was admitted to the hospital because of abdominal pain and bloody diarhea. Emergent colonoscopy was performed due to continuous bloody diarrhea on the following day after admission. Although edema, erosion, ulceration and hemorrhage were observed from the sigmoid colon through the cecum, inflammatory changes were more remarkable in the ascending colon with narrowing of the colon due to severe edema. Apparent inflammatory changes were not seen in the terminal ileum. Subsequently the stool culture was positive for Escherichia coli O157, resulting in the diagnosis of hemorrhagic colitis due to Escherichia coli O157 infection. Biopsy specimens revealed fibrin thrombosis in many vessels, closely similar to observations in ischemic colitis. It is therefore indicated that differential diagnosis from ischemic colitis is impor- tant. Her symptoms and inflammatory parameters improved with antibiotics without causing hemolytic-uremic syndromes, and no inflammatory findings were observed by colonoscopy performed on day 28 after the onset.