腸間膜血管閉塞症

As for the blood vessel obstruction of mesentery, there has been many reports since the first one by Dr. Fiedeman in 1843. But in our country there has been only 145 reports since the one by Dr. Fuji in 1914.<br>The increase of the numbera of the vessel obstruction uses can be said to give warning of increment of this vessel obstruction of mesentery, and there are many problems about the diagnoses or treatment of that.<br>Lately we have done a laparotomy, suspecting that the case is vessel obstruction of mesentery; soon recognizing that it is so, we could succeed in the operation by excision of bowel. And so we are going to report that and try to make statistical observation about the 145 cases in our country.<br>The case was a 76 years old male of cerebromalacia; he was admitted to the department of internal medicine of our hospital with c. c. of cloudiness of consciousness, On Aug. 22, during his stay in our hospital there appeared sudden pang of abdomen; being suspected to be vessel obstruction of mesentery, he was sent to the surgical department. Puncture of abdominal cavity was done at once, and there was found hemato-ascites; so we undertook the operation without hesitation. There was noticed necrotic part of bowel extending over from small intestines to colon and we cut that part off with success.<br>Observing 145 cases in our country, we noticed that most of these cases occured between the 4th to 5th decade, and chronologically to say, the number had lately increased, According to the sex distinction, male is more than female, As for the blood vessel, many were noticed in the upper mesentery and quite a few in the lower mesentery; more than half of obstructed vessel were arterial ones, As for the intestinal tube, many were noticed in small intestines especially in ileum, and quite a few in large intestiness.<br>As for the causes of this case, 22% are caused by arteriosclerosis and next 15.1% are noticed after laparotomy. Besides, there are rather many spontaneous cases which are unaccountable.<br>It is very difficult to make a diagnosis before the operation, there are only 8 cases in Japan which could be diagnosed correctly beforehand. As one of the diagnostic aids, X-ray diagnosis or puncture into abdominal cavity can be considered; and from our own experience the latter can be said very effective.<br>As the remedys there has been done 79 excision of intestines, 4 temporizing operations (making of artificial fecal fistula) or excision of embolus, 14 exploratory laparotomy, and 19 internal treatments.<br>Of course surgical treatment is superior to the internal one, considering the results of these cases and excision of intestines is best. But even in the case in which the excision of intestines was made, the death rate extends to 40%. The results of the other treatments are ineffective. As for the excision of embolus, there has been only a few cases without success in Japan, but it can be considered a progress of the treatment for vessel obstruction of mesentery and combined treatment with excision of intestines is desirable for the purpose of prevention of its relapse. In addition to this, using of anti-coagulant, low moleculardextran or adrenal cortical hormone will be effective.