虫垂切除術後に発見された回盲部単純性潰瘍の1例

Ileo-cecal Simple Ulcer Found after Appendectomy

　虫垂切除後45日目の注腸X線検査で，巨大な潰瘍を回盲部に認めた．回盲部切除標本には2個の開放性潰瘍（A，B）が存在した．組織学的には，いずれも単純性潰瘍であったが，潰瘍（A）辺縁部の固有筋層内に小さな縫合糸が見られた．改ためて全割切片を作製し，その組織学的再構築像から，本症例は縫合糸とは関係なく発生した単純性潰瘍であると診断したので報告する．

　A 47 year-old man was admitted to our hospital with complaint of the continuous right lower abdominal pain before appendectomy. Fourty-five days after appendectomy, barium enema study revealed a large irregular ulcer near the ileo-cecal valve. Then ileo-cecal resection was carried out.

　The resected specimen demonstrated two open ulcers (A and B). These two ulcers (A and B) were diagnosed as nonspecific, chronic, Ul-Ⅳ, openulcer. But threads were found at the base of the ulcer（A）.

　Because the spectrum of ulcer (A) with threads remained unsettled, step sections of the resected specimen were made up. The results of the histological examination were as follows: 　1) Threads were found at the oral edge of ulcer (A) only in the No.16 section. Histologically, acute, localized inflammation with polymorphs, lymphocytes and foreign body giant cells were observed only around the threads.

　2) No threads were found in ulcer（B) which was at the anti-mesenteric side. Ulcer (B) was located on the ileo-cecal valve as well as ulcer (A).

　3) Each of the two Ul-Ⅱ, open ulcers and Ul-Ⅱ ulcer scars was found in the terminal ileum, histologically. No threads were found in all of them.

　Therefore, this patient could be diagnosed as simple ulcer in the ileo-cecum, even if ulcer (A) did not exist. As to the spectrum of ulcer (A), it was concluded that ulcer (A) might have possibly occurred before appendectomy, indifferent from the threads.