非特異性多発性小腸潰瘍症の1例

A Case of Nonspecific Multiple Ulcers of the Small Intestine

　小腸の局在性の器質的病変は非常にまれで，しかももっとも有力な診断法であるレ線検査によっても病変を的確に把握することが困難なことなどから，この種の病変の診断はしばしば不正確なことが多い．著者らは約12年間の経過中に，腹痛，下痢，貧血，浮腫，低蛋白血症などを呈し，この間虫垂および胃切除術を受けたが症状の改善はみられず，輸血などの対症療法を繰りかえしていた患者を経験した．種々の検査を行ない，蛋白漏出性胃腸症を呈する回腸の出血性病変と考え開腹した結果，限局性回腸炎とも結核性病変ともいえない非特異性多発性回腸潰瘍と診断した症例を経験したので報告する．

　A 32-year-old female was admitted to Kanazawa University Hospital because of abdominal pain. She had been suffering from abdominal pain, anemia, diarrhea and edema for about 12 years. In spite of repeated treatments including blood transfusions, gastrectomy and appendectomy, the symptoms had not improved.

　On admission, she showed advanced emaciation, edema of the legs and poorly developed secondary sexual characteristics on physical examination. Laboratory examination revealed marked iron-deficiency anemia, hypoproteinemia (4.2 g per 100 cc), strongly positive occult blood in stool and an increased amount of gastroenteric bleeding (60.8 cc/day estimated by the ⁵¹Cr-method). She was diagnosed as proteinlosing gastroenteropathy from the results of RISA turnover test using an iodine binding ion exchange resin (Amberlite); i. e. shortened half-life (T1/2=2.6 days), increased loss of albumin (2.75 g/day) and serum (227. 5 cc/day) into the stool. X-ray examination of the G.I. tract showed an irregular contour of the mid-portion of the ileum accompanied by iregular mucosal pattern. A segment of it about 70 cm long, was resected approximately 50 cm from the terminal ileum.

　The mucosal surface of the resected specimen revealed a mixture of affected and grossly normal portions with clear demarcation. In general, the affected mucosa appeared flat. A few shallow ulcers and protruding areas consisting of mucosal thickening were noticed in the affected area. Histologically, superficial ulcers and nonspecific chronic inflammation which suggested alternating ulceration and healing were seen. Specific granuloma or lymphangiectasia was not observed.

　Fibroblastic proliferation of variable degree in the submucosa accompanied with cellular infiltration and thickening of the mucosal and medial muscle were present, though the changes were generally slight.

　The histological and clinical features seen in this case differed from those of typical regional enteritis. We believe that the patient had “non-specific multiple ulcers of the small intestine” which was described as a separate entity by Okabe et al. The patient recovered completely after the operation.