回盲部単純性潰瘍の1例

Simple Ulcer in Ileocecal Region, Report of a Case

　われわれは回盲部単純性潰瘍の典型例と思われる1例を経験したので報告する．

症例

　患　者：39歳，男．

　主　訴：右下腹部痛．

　家族歴：特記すべきことなし．

　既往歴：1968年（27歳）ごろより口内アフタを繰り返す．

　現病歴：1978年（37歳）ごろより右下腹部痛があったが放置していたところ，1980年6月初旬右下腹部痛が増強し，黒色便に気付いたため近医を受診し，大腸X線検査にて回盲部の異常を指摘された．1980年6月21日精査のため当科に入院した．

　A 39-year-old man was admitted to our hospital with complaints of right lower abdominal pain and blackish stool. X-ray examination disclosed an irregular, deep and sharply edged serial niche with marked converging folds in the ileocecal region and an ulcer scar with converging folds which was recognized in the proximal ileum close to the former lesion. Colonoscopy showed a white coated deep ulcer with converging folds which projected at the margin of the ulcer.

　On the resected specimen, a deep and undermined irregular ulcer (7.0×3.0 cm) with marked converging folds was noted in the ileocecal region. One ulcer scar and another active ulcer (2.5×0.3 cm) were found in the ileum, and they were located at 3. 5 and 19.5 cm proximal to the ileocecal valve respectively. The proximal two ulcerous lesions and most part of the ileocecal ulcer were situated at the antimesenteric side.

　Histological study revealed the most oral and anal ulcerous lesion to be Ul-Ⅳ and the middle lesion to be Ul-Ⅲ scar. None of the specific change was found and the lesion was diagnosed as nonspecific chronic ulcer.

　It is said that the differentiation of simple ulcer from intestinal Behçet's disease is impossible by morphological procedure alone without discussing the clinical criteria of Behçet's disease. This case was diagnosed as simple ulcer because there were not enough symptoms to suffice the criteria of Behçet's disease. The typical lesion of simple ulcer occurs in the ileocecal region, which always involves ileocecal valve and multiple ulcers are often associated in the proximal ileum and the ulceration usually appears to be deep, undermined form with marked converging folds. It is important for making a correct diagnosis upon simple ulcer that x-ray examination requires utmost care not only to depict the features of ulcer in the ileocecal region but also to disclose ulcers in the proximal ileum.

　As there have been a few reports of Behçet's disease which developed from simple ulcer, an extensive ileocecal resection should be required at operation of this disease as well as intestinal Behçet's disease to protect a patient from reccurent ulcer.