経過中にアフタ様病変を認めた潰瘍性大腸炎の1例

Ulcerative Colitis with Aphthoid Lesions, Report of a Case

要旨　患者は34歳，男性．血液が便に付着することを主訴に来院．症状に増悪傾向がないため，無治療だったが，2か月後増悪した，画像検査で横行結腸から下行結腸に散在性のアフタ様病変を認め，脾彎曲に区域性にびらん性病変を認めた．内視鏡検査での経過観察中，区域性の病変には変化なく，アフタ様病変は緩解増悪を繰り返していた．発症10か月目に直腸から横行結腸まで連続性びまん性の潰瘍性病変となり，典型的な左半結腸型のUCに進展した．本症例はUCの初期像やUCにおけるアフタ様病変の意義を考える上で，示唆に富む症例と考えられた．

　A 34-year-old man was admitted to our hospital with the complaint of blood on the surface of his soft stool. Colonoscopy and bariun enema showed multiple aphtoid lesions, which were predominantly located from the transverse colon through the descending colon, and diffuse, shallow and irregular ulcers in a segment in the splenic flexure. Seven months after the first examination colonoscopy revealed that the segment lesion of the splenic flexure showed no remarkable change, but the aphthoid lesions had progressed to rough-surfaced mucosa and multiple erosions. Eight months later, the patient again noticed mucous bloody stool. Colonoscopic examination and barium enema showed rough-surfaced mucosa and multiple erosions from the rectum to splenic flexure, suggesting typical ulcerative colitis, left-side type. This case seems to illustrate the progress of the initial lesions and aphthoid lesions in ulcerative colitis. The processes involved in ulcerative colitis have been but poorly investigated to date.