Abstract
患者は70歳台，男性．受診当日の朝より腹痛と下痢があり，当院救急外来を受診した．腹部CT検査で，S状結腸軸捻が疑われたため，内視鏡的整復術を施行した．整復後，一旦は症状の改善を認めた．その後，次第に血圧が低下し腹痛の増強を認めた．再度施行したCT検査では門脈内と，腸管壁内の気腫を認め，腸管壊死が疑われた．緊急開腹術を施行したところ，小腸（160cm）と大腸（横行結腸～直腸）に壊死所見があり同部位を切除した．48時間後のplanned reoperationでは，新たな壊死腸管は認めず，小腸小腸吻合および横行結腸人工肛門造設を行った．本症例はS状結腸軸捻後の脱水が契機となって非閉塞性腸管虚血症（nonocculusive mesenteric ischemia:NOMI）を発症したものと考えられた．
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