びまん性十二指腸炎の合併をみた潰瘍性大腸炎の1例

Diffuse Duodenitis Associated with Ulcerative Colitis, Report of a Case

要旨　患者は31歳，男性．24歳時発症の全大腸炎型の潰瘍性大腸炎の症例であり，薬物療法による緩解維持が困難であった．外科治療目的に当院へ紹介となった．嘔気と心窩部痛に対して行った上部消化管内視鏡検査で十二指腸球部から下行脚にかけて粘膜のびまん性の発赤とKerckring皺襞の腫大および多発するびらんが認められた．生検組織所見では粘膜層に著しい炎症細胞の浸潤と陰窩膿瘍が認められた．十二指腸病変はヒスタミン受容体拮抗薬に反応せず，methylprednisoloneの500mg/日3日間療法に反応し，緩解した．緩解時に結腸全摘除術が施行された．prednisoloneが漸減され10mg/日の維持療法時に腹痛はなかったが，上部消化管内視鏡検査で十二指腸炎の再燃が認められ，生検組織像で，前回有症状時と同様の炎症細胞の浸潤と陰窩膿瘍が認められた．

　A 31-year-old man who was diagnosed as having ulcerative colitis of the total colon type seven years ago was admitted to our hospital for surgical treatment. On admission, his main complaints were nausea and severe epigastralgia which were not typical symptoms of ulcerative colitis. Upper gastrointestinal (UGI) endoscopic examination revealed diffuse mucosal redness, thickening of Kerckring's fold and multiple tiny erosions from the bulb to the second portion of the duodenum. Biopsy specimens taken from the duodenum showed infiltration of numerous inflammatory cells into the mucosa and crypt abscess. Those findings were compatible with those in ulcerative colitis. Histamin receptor antagonist failed to decrease activity of the duodenal lesion but steroid reduced the symptoms and the activity of the lesion.

　Total colectomy was performed while the patient was in remission. Eight months later, treated by 10 mg prednisolone he was free from epigastralgia, but UGI endoscopic examination revealed recurrent duodenitis and histological examination of the duodenum revealed inflammatory cell infiltration and crypt abscess in the duodenal mucosa as was seen previously.