回盲部単純性潰瘍の術後に胃回腸結腸瘻を形成し，再発を繰り返した1例

Gastroilecolic Fistula Occurring as a Complication of Recurrent Simple Ulcer of the Ileocaecal Region, Report of a Case

要旨　患者は32歳，男性（韓国人）．5年前に，韓国（ソウル）で回盲部の潰瘍性病変に対して右半結腸切除術を受けている．1987年日本に留学．同年12月中旬から食欲不振，嘔気，嘔吐を来して近医を受診し，12月末，当科に紹介された．精査の結果，まず胃結腸痩（糞瘻）の存在が指摘され，その後の検索で，初回手術後の回腸横行結腸吻合部に生じた吻合部潰瘍と，それに起因する胃回腸結腸瘻（gastroileocolic fistula）と診断し，再手術（胃幽門側切除，回腸横行結腸部分切除術）を施行した．病理診断は回腸結腸吻合部の非特異性潰瘍（単純性潰瘍）に基づく胃回腸結腸瘻で，切除した回腸に多数の非特異性潰瘍が認められた．消化性潰瘍の術後やCrohn病の合併症例として胃小腸結腸瘻を来すことは知られているが，単純性潰瘍の術後に発生したとの報告はなく，本例が初めての報告例である．

　Report of a case of gastroileocolic fistula caused by the recurrence of so-called simple (non-specific) ulcer of the ileocaecal region. The patient, a 32-year-old Korean male, was admitted to the hospital with complaints of appetite loss, nausea, and vomiting. Five years previously, in Korea, he had had a right hemicolectomy for a non-specific ulcer of the ileocaecal region. Upper gastrointestinal series and barium enema demonstrated a gastroileocolic communication at the previous anastomotic site. Gastroendoscopy showed small orifices of gastrocolic fistulas containing fecal fluid. Distal gastrectomy with partial resection of the ileum and transverse colon was performed. Pathologic examination showed non-specific chronic ulceration at the anastomotic site. It had penetrated into the adherent surrounding stomach and ileum causing the formation of gastroileocolic fistula. There were also multiple shallow ulcers in the ileum. Follow-up of the patient showed further recurrence of an intractable punched-out ulcer at the ileocolostomy site. Gastroenterocolic fistulas can occur as a rare complication of recurrent peptic ulcer and Crohn's disease. However, to our knowledge, there have been no reports of formation of such fistulas in patients with simple ulcer of ileocaecal region.