潰瘍性大腸炎における非典型所見―縦走潰瘍

Morphological Study of Atypical Findings with Ulcerative Colitis: Longitudinal Ulcer

要旨　潰瘍性大腸炎（ulcerative colitis；以下UC）の非典型所見である縦走潰瘍（longitudinal ulcer；以下LU）について，形態的特徴，好発部位，臨床所見を検討した．明らかなLUはUCの17％にみられた．また典型的なLUではないが，縦軸の要素を持つ潰瘍は36％に認めた．LUは虚血性大腸炎（ischemic colitis；以下IC），Crohn病と同様に下行結腸に最も多かったが，UCは横行結腸にも多く認めた．LUのあるUCは21％が手術され，LUを認めないものより多かった．UCのLUは高齢者，罹病期間の長い症例に多く認め，治癒期の変形はICと似た変形がみられる症例があった．UCのLUの発生にはICの合併や虚血性変化の可能性も考えられた．

　To evaluate the charactaristic features of longitudinal ulcers in ulcerative colitis, 119 patients were analyzed. Typical longitudinal ulcers were noted in 17 percent of the patients with ulcerative colitis. Ulcers with longitudinal involvement were noted in 36 percent of the patients with ulcerative colitis. In the descending colon, longitudinal ulcers with ischemic colitis and Crohn's disease were frequently noted. The frequency of longitudinal ulcers with ulcerative colitis in the descending colon was simillar to the frequency of longitudinal ulcers with ischemic colitis and Crohn's disease. During the critical of the disease, resection of longitudinal ulcers was carried out in 21％ of the patients with ulcerative colitis. The cases of ulcerative colitis with longitudinal ulcers were more often operated on than those without longitudinal ulcers. Most cases of ulcerative colitis with longitudinal ulcers were aged patients, or patients who had been victims of the disease for long periods. The findings of the defomity in x-ray of ulcerative colitis with longitudinal ulcer scars resembled those of the deformity in x-ray of ischemic colitis with longitudinal ulcer scars. We considered that ulcerative colitis with longitudinal ulcers may be complicated ischemic colitis and/or lesions due to ischemic involvement.