鑑別に苦慮した潰瘍性大腸炎の1例

Ulcerative Colitis with Longitudinal Ulcer and Cobblestone Appearance, Report of a Case

要旨　患者は49歳，女性，主訴は水様性下痢と腹痛．近医から当院へ紹介された．当初，感染性腸炎・抗生物質起因性出血性腸炎が疑われたが，治療に反応しなかった．経過中の注腸X線検査では全大腸に連続性に潰瘍性病変がみられ，ステロイド療法により症状および画像所見は速やかに改善した．びまん性・連続性の病変は潰瘍性大腸炎を示唆するが，経過中に縦走潰瘍，敷石状所見がみられた．潰瘍性大腸炎の虚血性変化として縦走潰瘍がみられたと考え報告した．

　A 49-year-old woman was admitted to our hospital with watery diarrhea and abdominal pain. At first she was diagnosed as having infectious colitis or antibiotic-induced hemorrhagic colitis. However, TPN was ineffective and her general condition deteriorated. Barium enema study revealed disappearance of haustra, narrowing and multiple ulcers in the whole colon. Steroid therapy was administered and her clinical symptoms and x-ray findings improved rapidly. Diffuse and continuous lesions suggested ulcerative colitis, however, in the subsequent course, longitudinal ulcers and cobblestone appearance remained segmentally. Colonic ischemia due to ulcerative colitis was considered to be associated with the longitudinal ulcers.