超音波検査を機に診断し得た小児好酸球性胃腸炎の1例Pediatric Eosinophilic Gastroenteritis Diagnosed Using Ultrasonography: A Case Report
1 山梨厚生病院検査室Department of Clinical Examination, Yamanashi Kosei Hospital
2 山梨厚生病院小児科Department of Pediatrics, Yamanashi Kosei Hospital
1 山梨厚生病院検査室Department of Clinical Examination, Yamanashi Kosei Hospital
2 山梨厚生病院小児科Department of Pediatrics, Yamanashi Kosei Hospital
好酸球性胃腸炎はまれな疾患である.本疾患は発症年齢が幼児から成人までさまざまである.また,多くの症例では粘膜・粘膜下層の肥厚が主となるが,発生部位も全消化管が対象となるため超音波検査では診断が難しいと思われる.
患者は6歳未満幼児女性.腹痛,下痢,血便で当院入院.超音波検査で下行結腸から直腸にかけて粘膜下層を中心とする壁肥厚を認め,増悪時には潰瘍を疑う壁内のstrong echoを認めた.血中好酸球の増加,便中好酸球の出現,血清IgEの増加を認めたため,好酸球性胃腸炎疑いでプレドニゾロン(PSL)の投与を開始した.その後確定診断のため他院で下部内視鏡を行い,採取された組織から好酸球性胃腸炎と診断された.超音波検査は小児腹痛患者には被曝線量の観点からもファーストスクリーニングにおいては重要な位置づけとなる.決して確定診断には至らないが本疾患を疑う場合には好酸球の値に注意しながら経過を追うことが超音波検査の重要な役割と考える.
Eosinophilic gastroenteritis is a rare disease. The age of onset varies from children to adults. Mucosa or submucosa thickening is the main cause of eosinophilic gastroenteritis in many cases in Japan; however, its diagnosis is difficult because the site of occurrence is the entire gastrointestinal tract. We herein report the case of an under 6-yerar-old girl who was admitted to our hospital due to abdominal pain, diarrhea, and bloody stools. Ultrasonography revealed thickening of the wall, mainly in the submucosa, from the descending colon to the rectum. Moreover, strong echoes in the wall, suspected as ulcers, could be confirmed during exacerbation. Since an increase in blood eosinophils, appearance of fecal eosinophils, and an increase in IgE were observed, eosinophil gastroenteritis was suspected and prednisolone administration was initiated. Consequently, a definitive diagnosis of eosinophilic gastroenteritis was made from the tissue collected by colonoscopy. Ultrasonography is an important part of the first screening in pediatric abdominal pain patients from the radiation dose viewpoint. Although it never leads to a definitive diagnosis, the main role of ultrasonography is to follow the course while giving attention to the eosinophil level when eosinophilic gastroenteritis is suspected.
Key words: ultrasonography; eosinophilic gastroenteritis; child
© 2022 一般社団法人日本超音波検査学会© 2022 Japanese Society of Sonographers
This page was created on 2021-12-03T14:01:35.24+09:00
This page was last modified on 2022-01-20T08:07:58.000+09:00
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