反復する下血を主訴とした分類困難な小腸大腸炎の1例

Unclassified Enterocolitis Presenting with Intermittent Blood Stools, Report of a Case

要旨　患者は48歳，女性．主訴は反復する下血．家族歴，既往歴には特記すべきことなし．22年前より年に2～3回ほどの下血がみられ軽快しないため精査入院となる．入院時検査所見は，赤沈亢進，CRP陽性，γ-glb高値以外の異常は認められなかった．小腸，大腸X線検査および大腸内視鏡検査で回腸終末部に縦走潰瘍と多発する小潰瘍，上行結腸～盲腸に発赤調の小隆起を伴った粘膜が認められた．各種内科治療に抵抗するため手術を施行した．切除標本肉眼所見および病理組織学的検索では，既存の疾患群とは異なっており，本例は興味ある分類困難な小腸大腸炎と思われた．

　A 48-year-old female visited our hospital with a chief complaint of intermittent bloody stools. Past and family histories were unremarkable. History of the present illness included bloody stools twice or three times per year for the past 22 years. The symptom increased in frequency and she was admitted for further examination. Laboratory findings were unremarkable except for an accelerated ESR, a positive CRP, and a high γ-grobulin. Barium enema examination of the terminal ileum and colon, and endoscopic examination revealed longitudinal ulcers and small ulcers at the terminal ileum, and reddish mucosa with slight elevation in the cecum-ascending colon. The ulcers were resistant to various medical treatment, and a surgical treatment was undertaken. Macroscopic and microscopic findings of the resected specimen were not comparable to any groups of identifiable illness. Thus, enterocolitis in this patient seemed to fall within an unclassified group.