比較的高齢で発見された非特異性多発性小腸潰瘍症の1例

Nonspecific Multiple Ulcers of the Small Intestine, Report of a Case

要旨　患者は57歳，男性．腹痛，貧血(血色素5.7g/dl)を主訴に当科に入院した．Mantoux反応陰性，血清総蛋白5.9g/dlで，α₁anti-trypsin clearance testは192ml/dayと著明に高値であった．小腸X線検査では下部回腸に輪走ないし斜走する潰瘍による狭窄が多発していた．他の消化管には胃前庭部に潰瘍搬痕を認める以外異常なかった．狭窄症状を繰り返すため回腸部分切除術を行った．切除標本では再生上皮に覆われたUl-Ⅰ～Ⅱの潰瘍が多発し，組織学的に特異的な炎症所見を認めなかった．以上から非特異性多発性小腸潰瘍症と診断したが，潰瘍に治癒傾向を認め，比較的高齢で発見された点が典型例とは異なった．

　A 57-year-old man was admitted to our hospital with complaints of abdominal pain and anemia (hemoglobin content, 5.7 g/dl) . Laboratory data revealed no inflammatory signs, except for a protein loss from the gut (total protein, 5.9 g/dl; alpha₁-antitrypsin clearance test, 192 ml/day). Gastrointestinal radiography showed multiple ileal strictures of an annular or oblique arrangement. Gastroduodenoscopy and colonoscopy revealed only a healed ulcer in the gastric antrum. Because of the recurrent obstructive symptoms, the patient underwent a partial resection of the diseased ileum measuring 60 cm in length. The resected ileum showed multiple healed ulcers (Ul-II) with the normal looking overlying mucosa. Histologic examination indicated so-called “nonspecific multiple ulcers of the small intestine”. The patient has been asymptomatic without any treatments in the 18 months since surgery.