②回盲部単純性潰瘍の1例

A Case Report: Non-Specific Simple Ulcer in the Ileocecum

　最近，われわれは回盲部腫瘤を主訴とし，回盲部の非特異性潰瘍の1例を経験したので報告する．

症　例

　患　者：58歳　女性　主婦

　主　訴：回盲部腫瘤，全身倦怠感

　現病歴：1963年頃より時々口腔内，舌，咽頭部に有痛性アフタが出現していた．1964年九大耳鼻科で生検を行い非特異性慢性活動性炎症と診断された．1977年11月に，全身倦怠感，回盲部腫瘤に気付き某病院に入院した．回盲部に潰瘍を指摘され，精査，加療のため，九大第2内科に入院した．なお，外陰部潰瘍，眼症状，皮膚症状の既往はない．

　The patient is a 58-year-old female who has had intermittent aphtous stomatitis since 1963. General malaise developed in December, 1977 and she noticed a mass in the right lower quadrant. She, therefore, was admitted to Kyushu University Hosiptal for a further evaluation of the ileocecal mass. X-ray examination disclosed a single ulcer (2×3 cm) at the ileocecal valve but there were no other signs suggestive of Behçets disease except for aphtous stomatitis. Hyperalimentation and administration of salicylazo-sulfapyridin (salazopyrin^®) were tried but non-effective and eventually she underwent an operation. On the resected specimen, an undermining deep ulcer (2.3×2.5×0.7 cm) with clear-out margin and converging folds was noted. Three ulcer scars were also found at 12.5 cm, 20 cm and 35 cm proximal to the ileocecal valve. All of the ulcer scars located at the anti-mesenteric side. Histologically the ulcer was Ul-Ⅳ and ulcer scars were Ul-Ⅱ. Analysing the reported cases of non-specific ileocecal ulcer it seems to contain several diseases with different clinical feature. This case resembles intestinal Behçet's disease, however, it does not suffice its criteria. It is unlikely that Behçet's disease will develop in the future considering her age. On the other hand, most of the patients with ileocecal ulcer have characteristic clinical feature, namely ileocecal mass, fever, abdominal pain and melena, and pathological feature is also characteristic. Therefore it should be studied apart from other non-specific ulcers of the intestine.