KCl腸溶錠による小腸潰瘍の1例

Small Intestinal Ulcer Due to Enteric-coated KCl Tablets, a Case Report

　腸チフス，結核，梅毒，寄生虫，Crohn病，膠原病，尿毒症，メッケル憩室，Zollinger-Ellison症候群，胃腸吻合，レ線照射などとは関係のない，原因不明のいわゆる非特異的小腸潰瘍²⁵⁾は，従来まれと考えられていたが，欧米では1960年頃から急速に増加し注目を引いた^1)～6)．症例数の増加のほかに，臨床像にも変化がみられ，以前には穿孔が多かったのに対し，1960年以降では閉塞を起す例が多くなってきた^2)7)～9)．これらの症例中には，当時急速に普及したサイアザイド系利尿剤とその副作用であるK喪失を補うためのKCl腸溶錠投与を受けている例が多い事が報告された^1)～5)7)8)．臨床的にサイアザイドよりもKCI腸溶錠の方が関係が深いとされ，実験的にイヌ・サルなどにサイアザイドではできなかった小腸潰瘍がKCI錠によって作成されるにいたった^4)8)10)11)．このようにKCl腸溶錠によって小腸潰瘍が起るという考え方は，欧米ではほぼ確立されたものであり，その症例はすでに数百例に達するもようである．これに対し本邦では著者らの調べえたかぎり，まだ1例の報告もないようである．著者らは最近KCl腸溶錠によると思われる小腸潰瘍の1例を経験したので報告する．

　Case: a 60-year-old man. Chief complaints: abdominal pain and vomiting. Past history: Because of atrial fibrillation he was given digitalis along with three KCl tablets (enteric coating) a day from Sept. 1970 to Dec. 1971. Present illness: Since the end of Oct. 1971 he had frequent bouts of abdominal pain and vomiting, gradually losing much weight. On Feb. 23, 1972, he was admitted to our Department of Internal Medicine under a suspicion of subileus. Physical examination on admission: The abdomen was distended with peristaltic irritation. The bowel movement was normal. Special studies: ECK showed atrial fibrillation with coronary sclerosis. In the course of illness temporary hypoproteinemia was experienced. Urinalysis, blood cell counts, blood sedimentation rate, blood chemistry were all of normal results. The stool was from time to time positive for occult blood. Barium enema study: normal. Upper G. I. series with peroral contrast medium: Both the stomach and duodenum were normal. A constriction was observed in a part of the small intestine, with the segment oral to it distinctly dilated. Course of illness: Although vomiting subsided, diarrhoea persisted. On March 7 laparotomy was performed, for the moment only with by-pass formation. After the general condition of the patient had improved, the constricted segment (180cm long away from the Treitz's ligament) was excised, followed by end-to-end anastomosis. The postoperative course was uneventful. He was discharged on June 29.

　Resected specimen: The strictured part was just wide enough to allow a child's finger to pass through, with a Ul-IV ulcer about 5 mm in width located in the stenosed part. Adjacent and oral to the ulcer was seen a band of erosions 5 cm in width, extending over the entire circumference of the intestinal lumen. Histologically the lesion proved to be a non-specific ulcer.

　Ulcer of the small intestine due to ingested KCl tablets (enteric-coated) has often been reported in the western countries. As the findings of ulcer in the present case corresponded well with those of western reports, it is believed to have been caused by KCl tablets. As far as we were able to find out, this seems the first report in Japan of small intestinal ulcer due to KCl tablets.