⑤非特異性多発性小腸潰瘍症の1症例

Non-specific Multiple Ulcers of the Small Intestine: Report of a Case

　レントゲン診断技術の向上，内視鏡の開発等により小腸疾患の報告例は増加しつつあるが，小腸の非特異性疾患に関する考えはなお十分確立されているとはいえず，とりわけ小腸クローン病との異同が常に問題とされている．今回われわれは蛋白漏出性腸症を伴い，最終的に岡部ら¹⁾の“非特異性多発性小腸潰瘍症”と診断した症例を経験したのでクローン病との異同を中心に考察を加え報告する．

　A case of nonspecific ulcers of the small intestine associated with marked hypoproteinemia is reported. Stress is laid up on its clinical and pathological differentiation from Crohn's ileitis.

　A 32-year-old women was admitted because of pitting edema and abdominal distension of five months' duration. About one and a half year prior to admission, she had noticed occasional pretibial edema, at which time this disappeared without particular medical care. Her past history, family, and dietary background were not contributory. On admission she appeared as an emaciated female. No abdominal masses were present, but the mid-abdomen was slightly tender. Laboratory examinations disclosed a hematocrit value of 26%, hemoglobin level (Sahli) of 42% and RBC count of 296×10⁴. The serum protein was markedly decreased with a total protein of 3.6 g/dl and 47.6% albumin. The roentgenogram of the small intestine showed eccentric narrowing with pseudodiverticular formations and irregular shaped ulcers in part in the mid-portion of the ileum. The preoperative diagnosis was Crohn's ileitis associated with marked hypoproteinemia. During conservative treatments, her symptoms improved, but hypoproteinemia persisted.

　In February 1977, laparotomy was accordingly performed, and there was a marked involvement inflammatory process in mid-ileum with edematous thickening of mesenterium and discrete enlargement of the regional lymph nodes. An ileum of 135 cm in length was resected and jejunoileostomy was performed at the distal end of ileum. Urossly, there were multiple skipped shallow ulcers of serpigious shape in resected ileal segment. Histology, it revealed multiple ulcers extending into submucosa in broad fashion associated with remarkable submucosal fibrosis and its extension into the muscle layer. No granuloma was seen in involved ileum and regional lymph nodes. The patient made an uneventful recovery, and one month after operation, her total protein level was completely normal.

　Now two years since the operation, she has gained much weight and is completely free of preoperative symptoms.