①組織学的にクローン病類似所見を呈した虫垂切除後の非特異性の回盲部炎症

Non-specific Granulomatous Inflammation of the Ileo-cecum after Appendectomy: Report of a case

　組織学的にクローン病に類似した所見を示す炎症性病変が，虫切後の回盲部に認められたのでクローン病との異同を中心に報告する．

症　例

　患　者：29歳　男

　既往歴：1974年5月，虫垂切除術施行．結核の既往（－）．

　現病歴：1975年6月，入浴中回盲部腫瘤に気付く．自覚症状（－），腫瘤の大きさ不変．1975年9月，当科入院．

　A 29-year-old man was admitted to our hospital with complaint of a tender mass of the right lower quadrant. He had had appendectomy one year previously, Apart from positive Mantoux and Kveim tests, laboratory tests were all within normal limits. With barium enema, the cecum was not well distended and there was a narrowing of the terminal ileum with some rough granular appearance of the terminal ileum mucosa. Colonoscopy showed a polypoid mass in the cecum but neither ulceration nor cobblestone appearance was noticed. Biopsy histology showed chronic inflammation not suggestive of Crohn's disease or tuberculosis. To confirm the diagnosis and neglect possible malignancy, laparotomy and ileo-cecal resection with end-to-end anastomosis were performed. With laparotomy, an inflammatory mass was seen in the ileo-cecal region, but no abnormality was seen elsewhere. On opening the specimen, there was a polypoid mass of the cecum with thickening of the wall. A fistulous tract was found between the terminal ileum and the cecum, just about the site of the appendix orifice. Histological examination revealed transmural lymphoid infiltration of the bowel wall near the fistulous tract with many sarcoid-like granulomas with/without giant cells with no central caseation. Some granulomas are atrophic, being similar to those of Crohn's granuloma, whereas the others are more similar to those seen in sarcoidosis, In regional lymph nodes there were also many granulomas. Although histological appearances of granulomas were most similar to those of Crohn's granulomas; general macroscopic and microscopic appearances were inconsistent with those of Crohn's disease. As a similar case was reported in another hospital, it seemed most reasonable to assume that these inflammatory changes were secondary to appendectomy, probably due to rest abscess.