腸重積および空腸縦走潰瘍を呈したSchönlein-Henoch紫斑病の1成人例

Schönlein-Henoch Purpura Associated with Intussusception and Longitudinal Ulcer of the Jejunum, Report of a Case

要旨　患者は34歳，女性．関節痛，紫斑，腹痛，下血を主訴に入院．紫斑部の皮膚生検によりSchönlein-Henoch紫斑病と診断した．本症例では十二指腸から大腸まで病変を認め，内視鏡検査で十二指腸では粘膜浮腫，びらん，小潰瘍を，小腸では粘膜浮腫，縦走潰瘍を，また大腸では粘膜の発赤，出血斑が認められ，X線検査では小腸に腸重積，縦走潰瘍を，大腸に壁の伸展不良を認めた．入院後からprednisolone 60mg/日静注したが効果なく，methylprednisoloneによるパルス療法を施行したところ症状の著明な改善を認めた．空腸～空腸の腸重積をX線像で捉え，合併した空腸縦走潰瘍を内視鏡的に経過観察しえた報告例は見当たらなかった．この縦走潰瘍は，頻回の腸重積により虚血状態が持続し二次的に形成されたものと推測した．

　A 34-year-old woman was admitted to our hospital mainly complaining of arthralgia, purpura, abdominal pain, and hematochezia. From the exsistence of angitis in the biopsiy specimen of the skin, she was diagnosed as having Schönlein-Henoch purpura(SHP). In this case we observed endoscopically the whole extent of the intestinal lesions from the duodenum to thelarge intestine. Duodenoscopic examination revealed mucosal edema, diffuse erosion, and small open ulcers in the 2nd part of the duodenum. In the upper part of jejunum mucosal edema and longitudinal ulcers were observed by jejunoscopic examination. In the lower part of the colon, the redness of mucosa and hemorrhagic bleb were observed. By x-ray examination, an intussusception and a longitudinal ulcer was revealed in the upper part of the jejunum. In the large intestine, multiple stenotic segment due to intussusception was revealed in the sigmoid, descending and in the transverse colon. Although we administered 60 mg per day of predonisolone by injection from the first day of her hospitalization, it was not effective. So we treated her with large dose pulse therapy using methylprednisolone, which proved to be effective. Almost all of her symptoms improved quickly. In several weeks intestinal lesions were found to be cared. We could not find in the literature a case in which intussusception of the jejuno-jejunum was able to be observed endoscopically. From these observations, it was suggested that the mechanism responsible for the formation of longitudinal ulcers in the jejunum may be mainly ischemia secondary to continued intussusception.