下行結腸・S字状結腸移行部に発生した単純性非特異性潰瘍（線状）の1例

A Case of Simple Nonspecific Ulcers (Linear Type) in the Transitional Area between the Descending and Sigmoid Colon

　近年，大腸の単純性非特異性潰瘍は注目を集めてきており，本邦においても報告例が散見されるようになった．最近，著者らは下行結腸，S字状結腸移行部に発生した単純性非特異性潰瘍の1例を経験したので若干の考察を加え報告する．

症例

　患　者：山○ツ○，55歳，女子

　主　訴：便秘，左下腹部痛

　家族歴：特記すべきことなし

　既往歴：約5年前より高血圧症にて薬物治療を受けている．

　現病歴：27歳にて第2子を出産した後より1カ月に3ないし4回，軽度の腹痛を伴なう軟便ないし水様下痢をきたすようになった．しかしこれらの症状は止痢剤の服用にて短時日で軽快していた．この状態が2年前（53歳時）まで持続したが，この頃より次第に便秘に傾きはじめ，下痢は1カ月に1回位に減少した．数カ月前からは便秘はさらに頑固となり強い左下腹部痛を伴なってきたため，昭和46年7月10日当院に入院した．

　In this paper is reported simple nonspecific ulcer of the large bowel recently encountered, which is of such a rare occurrence in our country that only about a dozen cases have been reported so far.

　A 55-year-old woman was admitted to our hospital with chief complaints of constipation and pain in the left lower quadrant of the abdomen.

　Past history was not remarkable except medical treatment for hypertension lasting five years.

　She had been suffering at times from diarrhea since the age of 27 when she had been delivered of her second child. Constipation gradually developed since two years ago, becoming severe with abdominal pain for the past several months. On admission, a tumor-like mass was palpated in the left lower quadrant. The stool was positive for occult blood. Barium enema examination showed two linear ulcers, a single round ulcer scar and a diverticulum-like deformity, all located at the transional area between the descending colon with the sigmoid. Fibercolonoscopic examination revealed narrowing of the lumen, rigidity of the wall, superficial uneveness and bleeding over the mucosa.

　Romanoscopic finding was not remarkable. In the resected specimen was seen a linear ulcer scar, measuring 2.5 cm in length, in the antimesenteric side, in addition to a linear open ulcer, 3.1 cm length, and two ulcer scars in the mesenteric side. Three mesenteric lesions formed a line along the long axis of the colon. Diverticulum was not noticed. Histologically, all the lesions were simple nonspecific ulcers penetrating the submucosal layer with abruption of the lamina muscularis mucosae.

　She is doing very well as of one year after the operation. Her present laboratory findings are all within normal limits.