Stomach and Intestine(Tokyo) Volume 14, Issue 6 (June 1979)

Pathomorphologic Study of Simple Ulcer in Ileocecal Region H. Watanabe 1 , M. Enjoji 1 , T. Yao 2 1The 2 nd Dept. of Pathology, Faculty of Medicine, Kyushu Univ. 2The 2 nd Dept. of Internal Medicine, Kyushu Univ. pp.749-767
Published Date 1979/6/25
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 Simple ulcers of ileocecal region reported in the literature seem to be confused with other diseases, especially ulcers secondary to diverticulitis and ulcers of entero-Behçet's disease. In order to discriminate between them, we made a histopathologic comparative study, using eight cases of diverticular ulcer each accompanying multiple diverticula in the cecum and ascending colon, seven cases of complete or incomplete Behçet's disease and five cases of simple ulcer.

 All patients of diverticular ulcer complained of acute abdominal pain at the admission or in the past. The ulcers were round or oval with margin pulled down into their floor. The muscularis propria was penetratingly disrupted, being well preserved in its direction at the ulcer margin in most cases. The inflammatory infiltrate was fairly well demarcated in a shadow of diverticulum and, in its distribution, narrow in the muscularis propria and widest in the pericolic fat tissue. Therefore, on section, it made a form of an hourglass with a smaller head.

 Histologically, the infiltrate consisted of abundant neutrophils forming an acute abscess in the early stage, and of abundant plasma cells, neutrophils, lipophages, giant cells, lymphocytes and fibroblasts in the later stage.

 All patients of simple ulcer had a gradual onset of the disease. The ulcers were punched-out, round to oval with undermining margin. They were deep, Ul-Ⅳ, with disruption of muscularis propria near under destruction of muscularis mucosae. Microscopically the ulcers were entirely covered by a layer of neutrophils and necrotic tissue underlaid by a zone of vascular granulation tissue with predominant diffuse lymphocytic infiltration, and, in the serosal layer, by a cellular fibrous tissue though not prominent.

 Simple ulcers occurred on the ileocecal valve in all cases, where the ulcers were incurable, and were associated with daughter ulcers, Ul-Ⅱ to Ul-Ⅳ, in the ileum in four of five cases. In one recurrent case, ulcer occurred in the anastomotic site as well as in the ileum. Simple ulcers were seen in 65 per cent at the antimesenteric side, 31 per cent at the mesenteric and four per cent at the intermediate.

 Ulcers of entero-Behçet's disease were essentially the same to those of simple ulcers as regards to distribution, and macroscopic and microscopic appearance, but recurred in 57 per cent as compared to 20 per cent recurrence in the latter.

 It is quite possible to differentiate simple ulcer from diverticular ulcer histopathologically. However, differentiation of simple ulcer from ulcer of entero-Behçet's disease is morphologically impossible to our today knowledges. Until the time of fully explaining the difference between them, simple ulcer should be dealt with as a separate entity of disease.

Copyright © 1979, Igaku-Shoin Ltd. All rights reserved.


14巻6号 (1979年6月)
電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院