回腸穿孔の既往を有し回腸に潰瘍形成を認めた好酸球性胃腸炎の1例

Eosinophilic Gastroenteritis Associated with Perforation and Ulceration of the Ileum, Report of a Case

要旨　患者は50歳，男性．下腹部痛，下痢，腹満感，食欲不振，全身倦怠感を主訴として入院．47歳時，腸穿孔で他院において緊急手術，回腸切除の既往歴あり．末梢血白血球数，好酸球数の軽度増加を認めた．経口小腸造影およびゾンデ法小腸造影で下部回腸に約10cmの管腔狭窄，浮腫状に腫大した皺襞およびその口側小腸の拡張を認めた．内視鏡的には浮腫状に腫大蛇行した皺襞上に活動性の小潰瘍を認めた．同部からの生検で粘膜下層に著明な浮腫と好酸球を主体とした炎症細胞浸潤を認めた．前医での回腸切除標本の見直しで好酸球浸潤は腸壁全層に認められ，好酸球性胃腸炎と診断した．中心静脈栄養療法のみで，症状軽快，腫大した皺襞は消失し，潰瘍も瘢痕を残さず治癒した．

　A 50-year-old man was admitted to our hospital with complaints of lower abdominal pain, loss of appetite and general malaise. He underwent ileal resection due to perforation at the age of 47 at another hospital. Laboratory data at admission disclosed mild leucocytosis and eosinophilia. Radiographic examination of the small intestine demonstrated a luminal narrowing (approximately 10 cm in length), edematous folds and proximal dilatation in the distal ileum. Endoscopic examination of the ileum showed a solitary round ulcer on edematous and tortuous mucosal folds. Biopsy specimens taken from the edge of the ulcer revealed marked edema and diffuse eosinophilic infiltration in the submucosal layer. Re-examination of the previously resected ileal specimen showed transmural infiltration of inflammatory cells, chiefly eosinophils. He was successfully treated with total parenteral nutrition only. Follow-up barium enema three weeks later showed the disappearance of edematous folds and the healing of an ulcer.