十二指腸第2部に潰瘍性病変を伴った非特異性多発性小腸潰瘍症の1例

Non-specific Multiple Ulcer of the Small Intestine Accompanied by Duodenal Ulcer Lesion, Report of a Case

要旨　患者は30歳，女性．主訴は貧血と腹痛である．小腸X線検査では，充盈像で下部小腸に多発する辺縁硬化像，口側の軽度拡張をみる狭窄像，偽憩室形成を認めた．低緊張性十二指腸造影上，十二指腸第2部に狭窄と粘膜集中像を，同部の内視鏡で，輪状の浅い活動性潰瘍を認めた．以上より十二指腸病変を伴う非特異性多発性小腸潰瘍症と診断し，狭窄高度でイレウス症状があるため病変部小腸47cmを切除した．切除標本においても術前検査と一致する所見がみられた．本疾患では，術前に十二指腸病変の存在を指摘した報告はなく，小腸以外の腸管病変の存在も念頭におく必要があると思われた．

　A 30-year-old female patient complaining of anemia and abdominal pain was admitted to Fukuoka University Chikushi Hospital in April 1990. She had a long history of anemia and persistent melena. Laboratory examination showed hypochronic anemia and strongly positive fecal occult blood. X-ray examination of the small intestine revealed multiple focal rigidities, mild to severe stenosis with slight dilatation of the oral side lumen and pseudo-diverticular formation in the distal segment of the small intestine. Hypotonic duodenography showed stenosis and fold convergency in the second portion at which duodenoscopic examination showed a circular active ulcer. Based on these typical history and x-ray findings, she was diagnosed as having non-specific multiple ulcer of the small intestine with a duodenal lesion.

　Because of repeated symptoms of intestinal obstruction, she underwent ileal resection. Histological findings were compatible with the preoperative diagnosis.

　Among the cases ever reported of non-specific multiple ulcer of the small intestine, this is the first case accompanied by duodenal lesion without prior intestinal resection.