大腸深在性囊胞症を合併した潰瘍性大腸炎の1例

Ulcerative Colitis Accompanied with Colitis Cystica Profunda at the Cecum, Report of a Case

要旨　50歳，男性．下血で入院．2年前の下血時に精査を行ったが出血源は不明であった．今回の出血時に行った緊急内視鏡検査で，出血源は虫垂起始部の盲腸粘膜にみられた10mm大の平坦な隆起性病変であった．切除材料で，虫垂起始部盲腸粘膜に10mm大の平坦な隆起性病変がみられ，中心部にびらんと出血がみられた．同部は，組織学的に潰瘍性大腸炎の所見を呈し，これに大腸深在性囊胞症（膿瘍を合併）の所見を伴っていた．虫垂と上行結腸は肉眼的に異常を示さなかったが，組織学的には潰瘍性大腸炎の所見を示した．その後の大腸内視鏡検査で上行結腸はびらん形成を示したが，直腸は点状出血のみで，生検でも潰瘍性大腸炎の所見はなかった．本症例は盲腸，虫垂突起を主体とした右側結腸型潰瘍性大腸炎で，二次的に発生した膿瘍合併の大腸深在性囊胞症が出血源となったものと考えられた．

　A 50-year-old man was admitted to Hakodate Central General Hospital because of melena. Colonoscopic examinations revealed bleeding from a flat elevated lesion with erosion at the cecum, the orifice of the appendix. No findings of angiodysplasia were revealed by angiography. The resected specimen revealed the flat elevated lesion with erosion, 10 mm in diameter, at the cecum, the orifice of the appendix. Histopathological findings revealed thickened cecum mucosa with massive infiltrations of lymphocytes and plasma cells. Elongated misplaced mucosal glands were seen in the submucosal layer with destruction of the mucosal muscle layer. Fibromusculosis, abscess and granulation formations were also seen in the submucosal layer. Appendicial and cecum mucosa revealed crypt abscess formation and granulomatous lesions with superficial inflammation. In the follow-up study the ascending colon mucosa revealed erosion formations with crypt abscess formation. Nevertheless rectal mucosa revealed only petechiae with nonspecific inflammation. This case was ulcerative colitis localized within the cecum and appendix, accompanied with colitis cystica profunda.