特異な膵管像を示す膵炎を合併した潰瘍性大腸炎の1例

Ulcerative Colitis Associated with Pancreatitis, Report of a Case －Some Characteristic Changes Observed at Pancreatography－

要旨　患者は18歳，男性．心窩部痛を主訴とし近医を受診，血清elastase 1の異常高値を指摘され当科で精検，初回のERCPで頭部主膵管の不整狭細化を認め，膵外分泌機能試験（セクレチン試験）でも3因子の低下をみた．血清elastase 1は異常高値が持続し，1年後に正常化した．慢性膵炎として経過観察中，排便時出血が出現し，直腸炎に続き全大腸炎型潰瘍性大腸炎を発症した．更に第2回のERCPでは膵管像の異常は著明に改善した．患者は若年者であり，ほかに膵炎を起こす素因もないことと，膵管像の異常が改善したという特殊な経過から2つの疾患の間の病因上の関連が示唆された．

　An 18-year-old boy was admitted to Meijo Hospital, suffering from epigastric pain in July 1985. Serum elastase 1 was markedly elevated but there was no hyperamylasemia. The first ERCP demonstrated a narrow and irregular main pancreatic duct in the pancreatic head (Fig. 1 a). Pancreatic evaluation (secretin test) revealed exocrine pancreatic insufficiency. Upper gastrointestinal series, ultrasonography and computerized axial tomography of the abdomen were normal. Alcoholism, gallstone, hyperlipidemia and medication were not recognized as causes of pancreatitis. The elevation of serum elastase 1 continued for about one year (Fig. 2). Bloody stool occurred five months later, but barium enema (Fig. 3 a) and colonoscopy were normal. The second barium enema study (Fig. 5 a), colonoscopy (Fig. 4) and colonic biopsy (Fig. 6) revealed nonspecific proctitis in June 1986. In March 1987, there was a severe attack of colitis. The third barium enema study (Fig. 3 b, 5 b), colonoscopy (Fig. 7) and colonic biopsy (Fig. 8) six months after the first barium enema study showed typical pictures of ulcerative colitis (total colitis type). The second ERCP in March 1988 demonstrated an improvement on the previous one, and changes in the pancreatic head (Fig. lb, c).