特異な臨床像と病理所見を示した非特異性多発性大腸潰瘍の1例

A Case of Nonspecific Multiple Ulcers of the Colon with Peculiar Clinicopathological Features

　最近，われわれは下血を主訴とし盲腸より横行結腸にかけて約50個の浅い潰瘍を有したいわゆる非特異性大腸潰瘍の1症例を経験した．従来，このような症例の記載はないと思われるので報告する．

　A 41-year-old man was admitted with a complaint of massive melena.

　X-ray examination of the gastrointestinal tract did not reveal any organic abnormality in the esophagus, stomach, duodenal bulb and small intestine. Barium enema showed irregular barium flecks and a great number of rugal convergency ranging from cecum to right half of transverse colon, which were arranged longitudinally in two lines. But it showed normal marginal contours with normal haustral patterns all through the colon.

　Endoscopy of the colon showed numerous lesions in cecum, ascending colon and right half of transverse colon. They were produced by shallow ulcers of various stages from active ones to scars with a large number of rugal convergency. No remarkable changes were observed in the mucosal and vascular patterns between the lesions.

　Right hemicolectomy was performed with a clinical diagnosis of nonspecific multiple ulcers of the colon. Examination of the resected specimen revealed about fifty shallow ulcers of various stages from active ones to scars which were mostly arranged longitudinally in two lines, ranging from cecum to transverse colon.

　Microscopically the ulcers remained in the mucosa and submucosa, the muscularis propria being intact and infiltration of inflammatory cells also localized within submucosa.

　Diseases producing ulcers in the colon, such as Crohn's disease, ulcerative colitis, intestinal tuberculosis, Behcet's disease and so on, were excluded. And we arrived at a diagnosis of nonspecific ulcers of the colon.

　We made a review of the medical literature concerning nonspecific ulcers of the colon, collecting 159 cases in foreign series and 39 cases in Japanese series.

　Nonspecific ulcers of the colon as were seen in this case have never been reported before.