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要旨 患者は36歳の男性で,主訴は臍下部痛であった.来院3か月前より持続的な鈍痛を覚えるようになり,近医で胃X線検査,大腸X線検査,腹部エコーなどが行われたが異常はみられなかった.症状増悪のため当科に紹介入院となった.小腸X線検査で,回盲弁から約40cm口側に幅2.5cmの著明な狭窄がみられ.周堤形成,縦長潰瘍の存在も疑われた.切除標本では,大きさ3.5×2.0cmの境界明瞭な下掘れ潰瘍が腸間膜付着側に存在し,周辺の膨隆もみられた.しかし,縦走潰瘍は存在しなかった.組織学的には潰瘍はUl-Ⅳであり,線維性結合組織の増生により腸管壁は著しく肥厚していた.病理学的診断は単純性潰瘍であった.自験例の潰瘍はまれな部位に発生したことから術前に小腸癌,Crohn病との鑑別を要した.
The patient was a 36-year-old male with a complaint of continuous dull pain under the umbilicus for the last 3 months. He had undergone an upper GI series, a barium enema and an abdominal US at another hospital and was told that no abnormal findings were noted. He was referred to our hospital because of increasing abdominal pain. A small intestinal roentgenography at our hospital demonstrated a severe stenosis, 2.5 cm in length, at about 40 cm oral from the Bauhin's valve. Coexisting longitudinal ulcer and marginal elevations were also suspected (Figs. 1-3).
Examination of the resected specimen showed a deep and clearly demarcated ulcer, 3.5×2.0 cm in size, on the mesenteric side with marginal elevations but without a longitudinal ulcer (Fig. 5). Histologically, the depth of this ulcer was Ul-Ⅳ and the small intestinal wall was markedly thickened because of the proliferation of fibrous tissue (Fig. 6). Based on these findings this lesion was diagnosed to be a simple ulcer in the ileum.
It would be relatively unusual that a simple ulcer occurs in the ileum. Therefore, it was necessary to differentiate it from adenocarcinoma or Crohn's disease before the operation.
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