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

A Case Report; Multiple Ileocaecal Ulcers Which Developed During the Remission of Incomplete Type Behçet Disease K. Tominaga 1 1Department of Pathology, Tokyo Metropolitan Komagome Hospital pp.795-801
Published Date 1979/6/25
  • Abstract
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 We experienced a case of incomplete type Behçet disease which had no ocular lesion and had been asymptomatic for over the last 5 years but developed multiple ulcerations in the ileocaecal region.

 The patient was a 37 year-old barber who was doing well until 1960 when he developed recurrent aphtous stomatitis, arthralgia and ulcers in the penis as well as scrotum. He, however, became asymptomatic in 1970 and did well until 1975 when right upper quadrant abdominal pain developed. Work up in our institution disclosed multiple ileocaecal ulcerations and ileocaecal resection was performed under a tentative diagnosis of Crohn's disease. Macroscopic findings of the resected specimen disclosed 1) two ulcer scars (A, B) in the ileum, located at 9 and 18 cm proximal to the ileocaecal region, 2) ileal ulcer (C), classified as Ul-Ⅲ, which was 0.3 cm in diameter and located at 6 cm proximal to the ileocaecal valve and 3) punched out ulcers (D, E), classified as Ul-Ⅳ, at the ileocaecal region.

 Histological examination revealed no specific findings in these ulcers and ulcer scars. However, marked fibrosis and mononuclear cell infiltration as well as various size of lymphoaggregation with germinal center were noted in the bases and margins of the ileocaecal ulcers (D, E). In those ulcer bases and ulcer margins, vascular lesions (fibrous thickening of the intima, obliteration and narrowing of the vessel lumen secondary to thrombosis) were also noted in the small to middle sized vessels and they were felt to be the secondary change due to the ulcer.

 On the other hand, the similar lesions, although it was more prominent in small veins than arteriolen, were noted in submucosa and serosa of the adjacent as well as apart areas from the ulcers where no fibrosis was observed. These lesions seen in veins were too severe to consider as secondary lesion and in fact, it's location was far away from the ulcer. Therefore, these lesions were felt to be the primary lesion causing the ulcers. Post-operatively, he developed leakage from the anastomosis and reanastomosis was performed on Feb. 18,1976. Currently he, however, has been doing well without any obvious symptoms of Behçet 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