6年間の経過観察中に再発を繰り返した腸型Behçet病の1例

Intestinal Behçet's Disease Having Undergone Three Resections of the Intestine during Six Years, Report of a Case

要旨　不全型腸型Behçet病のため，6年間に3回の腸切除術を受けた1例について報告した．患者は，12歳ごろから口腔内アフタを繰り返していたが，19歳になって回盲部腫瘤のため結腸右半切除を受け，上行結腸に巨大な非特異性潰瘍を認めた．腸型Behçet病の診断のもとに，predonineを主とした保存療法が開始されたが，腹痛，口腔内アフタ，肛門潰瘍，皮疹の寛解・憎悪を繰り返していた．治療開始後5年目には大量出血，6年目には穿孔性腹膜炎によりそれぞれ腸切除術が施行されたが，縫合不全，敗血症を併発して死亡した．Behçet病の腸管潰瘍は厳重な管理にもかかわらず再発しやすく，急激な経過をとり，内科的治療に抵抗する．

　A 19-year-old male patient had a hemicolectomy because of a mass with severe pain in the ileocecal region. A resected specimen showed a large ulcer in the ascending colon and small ulcer scars in the cecum (Fig. 4). Histologically, the ulcers were non-specific ulcers. Since intestinal Behpet disease was diagnosed because of relapsing oral aphthas (Fig. 6) and anal ulcers (Fig. 7) after the operation, he had been under predonine therapy. Five years later, he had the second resection of the intestine because of massive melena due to recurrent ulcers in the ileum (Fig. 9). Six months after the second operation, he had the third resection because of another perforated ileal ulcer (Fig. 10) and died of anastomoric dehiscence and sepsis. Intestinal Behçet is an intractable disease entity even under strict medical management.