A Case of Nonspecific Multiple Ulcers of the Small Intestine N. Sawabu 1 , E. Takazakura 1 , K. Kobayashi 1 , F. Matsubara 2 , M. Tsuji 3 1The First Dept. of Int. Med., Faculty of Medicine, Kanazawa University 2The Central Clinical Laboratory, Kanazawa University Hospital, Faculty of Medicine, Kanazawa University 3The Second Department of Surgery, Faculty of Medicine, Kanazawa University pp.219-224
Published Date 1972/2/25
DOI https://doi.org/10.11477/mf.1403109008
  • Abstract
  • Look Inside

 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.

Copyright © 1972, Igaku-Shoin Ltd. All rights reserved.


電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院