小児の潰瘍性大腸炎

Ulcerative Colitis in Childhood, Report of a Case

　潰瘍性大腸炎は，その本態，および成因について，明確な定義はなされていないが，1903年Boas¹⁾がColitis ulcerosaと記載して以後，―独立疾患とみなされるに至った．本邦においては，1928年稲田²⁾が，重症大腸炎として報告以来，数々の報告がなされ，詳細は松永³⁾により，第55回内科学会総会の宿題報告として，259例についての検討がなされている．小児科領域での本症は，比較的稀な疾患⁴⁾で，欧米では，Helmholz⁵⁾によれば，Logan⁶⁾による1例報告が最初のようであり，本邦では，1952年中山⁷⁾による乳児の剖検例が報告されている．われわれは，最近小児の潰瘍性大腸炎の経過観察をする機会に恵まれたので，ここに報告する．

症例

　患　者：11歳6ヵ月，男児（長男）．

　主　訴：下血．

　家族歴，既往歴：特になし．

　現病歴：当科初診の約1年位前より，有形便周囲に鮮血が附着する事に気付いたが，近医にて痔といわれ，坐薬を使用してしばらく止まっていた．7カ月前頃から前回同様の下血が始まり，薬物療法を受けるも軽快せず，貧血増強したため，他病院へ転院し，諸検査の結果潰瘍性大腸炎の疑いにて，ステロイド投与，ACTH，輸血等を受け，下血は止まった．しかし，ステロイドを中止したところ，高熱並びに下血が始まり，次第に増強して来たので，千葉大学附属病院小児科へ入院した．

　Ulcerative colitis in childhood is a rare disease in Japan. A child with ulcerative colitis who was studied over a year and a half is described.

　A 11-years-old male child was admitted to Chiba University Hospital in July 1971 because of bloody stool. One year previously he had begun to have episodes of bloody stool without diarrhoea. He was treated conservatively in other hospital, but his symptom was not improved.

　He was referred to our hospital because of this puzzling picture. On admission, physical examination was entirely normal except for mild moon face and moderate tenderness at the right lower quadrant.

　He was having 2 or 3 bowel movements a day. Laboratory findings included a red blood cell count of 3,950,000 and a hemoglobin of 8.6 g per 100 ml. Stools were positive for occult blood and blood sedimentation rate was 25 mm per hour.

　Barium enema showed abnormal barium coating, fein spiculations along the margin of the colon, irregularshaped niches and disappearance of network pattern of the mucosa. Absent vessel pattern, numerous bleeding spots and some erosions were recognized in the endoscopic examination. Biopsy specimens revealed crypt abscess, infiltration of inflammatory cells, atrophy of the gland of Lieberkuhn and fibrosis in the submucosal layer.

　He was diagnosed as ulcerative colitis and enema of corticosteroids was then begun. He responded well to treatment and his symptom disappeared within a few weeks. Salazopyrin was administrated after cessation of corticosteroid therapy. He has been asymptomatic for the past 12 months.