多数の肉芽腫を伴い多結節状粘膜下腫瘍の形態を呈した回盲部慢性憩室炎の1例

An Unusual Presentation of Ileo-cecal Peridiverticular Abscess with Many Epithelioid Cell Granulomas

要旨　患者は43歳男性で，17歳時虫垂切除術の既往がある．2003年5月から発熱，右下腹部痛を繰り返して抗生剤を服用していたが，2003年11月7日，症状が再燃し当科を受診した．回盲弁を取り巻くように径7cmの発赤を伴う多結節状充実性粘膜下腫瘍様隆起を認め，回盲部切除術を行った．組織学的には回腸憩室周囲に線維化と形質細胞を主体とした慢性炎症細胞に好中球浸潤を伴う膿瘍形成を認め，慢性再発性に経過した憩室炎と診断した．周囲リンパ節や憩室周囲粘膜内には多数の類上皮細胞肉芽腫を認めた．全消化管の検索を行ったが他に異常はなく，術後炎症反応は消失した．現在までCrohn病などの肉芽腫性腸炎の所見はない．

　A 43-year-old Japanese man, who had a history of appendectomy at 17 years old, was admitted to our hospital because of recurrent abdominal pain and fever. Colonoscopy showed multi-nodular elevated lesions covered by hyperemic normal mucosa around the ileo-cecal valve, where diverticula were evident on radiography. Histologic examination of the resected specimen revealed chronic diverticultis in the ileo-cecal region. The diverticular abscess was comprised of chronic inflammatory cell infiltration with neutrophils. In addition, many epithelioid cell granulomas were recognized in the ileal mucosa and surrounding lymph-nodes. His postoperative course was uneventful. To date, there has been no findings of granulomatous entero-colitis, including Crohn disease, tuberculosis, and sarcoidosis.