⑦Behçet病不全型患者の寛解期に発生した回腸および回盲部の多発性潰瘍

A Case Report; Multiple Ileocaecal Ulcers Which Developed During the Remission of Incomplete Type Behçet Disease

　われわれは眼病変を欠くBehçet病不全型患者において，5年間の無症状期後に生じた回腸および回盲部多発性潰瘍（およびその瘢痕）の1手術症例を経験したので報告する．

症　例

　患　者：37歳　男　理容師

　主　訴：右下腹部痛

　家族歴：特記事項なし

　現病歴：1953年頃より主に両側前腕に職業柄，石けんによる水洗後によくアセモ様湿疹が出来，発赤腫脹を繰り返す．1960年，1965年，1972年に口内アフタ性潰瘍が出現し，1965年から1966年にかけて3回，亀頭および陰囊に潰瘍が生じた．1970年に数カ月の間隔で3回，右手首，両膝に関節痛があリデカドロン（総量12.0mg）を内服し症状は改善され以後健康であったところ，1975年6月頃から心窩部痛と下腹部痛が続き，8月20日頃から右下腹部痛が出現し8月22日に本院内科に入院した．発熱，下痢，下血はなく，全経過を通じて眼症状，神経症状は生じていない．

　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.