虫垂開口部病変が先行したと思われる潰瘍性大腸炎の1例

A Case of the Ulcerative Colitis Preceding the So-called “Ulcerative Appendicitis”

要旨　潰瘍性大腸炎の直腸炎型～左側大腸炎型の約30％では，虫垂に炎症を伴う“ulcerative appendicitis”を合併すると言われている．今回筆者らは，虫垂病変が先行したと思われる潰瘍性大腸炎の1例を経験した．患者は46歳，男性．検診で便潜血検査陽性を指摘され，全大腸内視鏡検査を施行された．直腸～左側大腸には特に異常を認めず，虫垂開口部に潰瘍性大腸炎様所見，上行結腸に非連続性に小病変を認めた．虫垂からの生検では潰瘍性大腸炎に矛盾しない所見を認めたが，直腸生検では炎症はほとんどみられず，寛解期の所見もみられなかった．1年後の経過観察では虫垂病変は軽度改善を認めたが，直腸には著変はみられなかった．さらに2年半後には，直腸に典型的な潰瘍性大腸炎の所見が出現し，虫垂病変は寛解していた．初期病変としての“ulcerative appendicitis”の可能性が示唆された．

　It was said that the lesion of 30％ of patients with distal ulcerative colitis（left-sided colitis and proctitis）were complicated with appendiceal inflammation called “ulcerative appendicitis”. A 46-year-old man presented due to positivity of fecal occult blood testing（FOBT）. The physical and laboratory examinations were normal. Total colonoscopy was performed. Endoscopic findings showed the typical findings of ulcerative colitis only in the appendiceal orifice and showed redness, and tiny erosions in the ascending colon skipped from the appendix. There were no significant findings in the distal colon including the sigmoid colon and the rectum. Histological findings of the biopsy specimen taken from the appendiceal orifice showed typical ulcerative colitis such as mucosal inflammation and crypt abscess. Three and a half years later, TCS and biopsy from the rectum and the appendiceal orifice were also performed. It showed the typical findings of the UC in the rectum and remission in the appendiceal orifice. This case showed that so-called “ulcerative appendicitis” was preceded by UC in this patient.