Behcet病の経過中に盲腸潰瘍を伴った1例

Simple Ulcer of the Cecal Region with Behcet Disease: A case report

　Behcet病にて，約10年間の経過観察中に消化器症状が出現し，X線検査にて回盲部に潰瘍が認められたために手術した症例を経験したので報告する．

症例

　患者：39歳主婦

　主訴：回盲部圧痛

　既往歴：19歳の時，虫垂炎と胆嚢炎にて虫垂切除術，胆嚢切除術をうけた．

　現病歴：1965年（29歳）頃より，口腔内にアフタ出没する．1970年（34歳）外陰部に潰瘍出現し，福島医大皮膚科で外来通院をしていた．刺創で静脈炎を起こしたり，化膿しやすい傾向があった．1973年（37歳）頃より，目がときどきかすむようになり，同大眼科に通院していたが，①虹彩毛様体炎，②網膜脈らく膜炎などのBehcet病に特徴的な眼病変はみられなかったという．1974年，首より上にアクネ様湿疹が出現した．1975年（39歳）3月19日右側下腹部にしめつけられるような痛みがあり，4時間ぐらい持続し，自然軽快する．その後，同様の主訴がほとんど連日のようにあった．tarrystool様の便が4日ほどつづいたため同年4月21日当科へ入院した．

　A 39-year-old female had a chief complaint of ileocecalgia. She had been treated at the department of dermatology under a diagnosis of recurrent aphthous stomatitis and genital ulcers. She was diagnosed to have incomplete type of Behcet disease 10 years ago. She was admitted to our department because of abdominal symptomes. X-ray examination revealed a large irregular shaped ulcer in the ileocecal region.

　Surgical treatment was undertaken because it was considered intractable and perforation was suspected from a view point of all experienced our cases and literature survey. Therefore ileo-cecal resection was performed and a large irregular ulcer, measuring 4.5 by 2.7cm in size, was, found in the cecum, near the Bauhin's valve. Its margin was sharp and underminding. A small elevated lesion, 4 by 5mm in size was also recognized at 9cm proximal to the terminal ileum.

　Histologically, the ulcer was nonspecific and deep enough to be classified to Ul-Ⅳ, but not penetrated or perforated. The small elevated lesion mainly consists of marked lymph aggregates.

　In spite of removal of ileo-cecal region, symptomes other than intestinal tract did not improved.