術後小腸に炎症が再発した潰瘍性大腸炎の1例

Postoperative Recurrence of the Ulcerative Colitis in the Ileal Reservoir, Report of a Case

要旨　患者は27歳，男性．2年前に全大腸炎型潰瘍性大腸炎の診断で全結腸切除回腸直腸吻合術を施行されており，血便，下痢を主訴に再入院となった．吻合部より口側約50cmにわたって不整型の辺縁に発赤のある潰瘍の多発，非潰瘍部粘膜の発赤を認めた．生検ではびまん性の炎症で潰瘍性大腸炎の再燃と診断した．直腸は炎症の治癒像を示していた．切除標本では肉眼的には回腸は正常であったが，組織学的には炎症を認めていた．潰瘍性大腸炎は大腸を切除すれば再発しないと言われているが，backwash ileitisが少なくとも組織学的レベルでは決してまれでない．本症例のように小腸再燃をみる場合もあり，潰瘍性大腸炎は大腸に限局した炎症との考えは修正を迫られる．

　A 25-year-old man underwent total colectomy because of severe ulcerative colitis in 1980. He was readmitted to our hospital 2 years later because of bloody diarrhea. Multiple ulcerations with redness in the surroundings were shown by colonoscopy. Diffuse and uninterrupted inflammatory changes in the lamina propria were found on microscopic examination of the interposed mucosa. These findings led us to the diagnosis of postoperative recurrence of ulcerative colitis in the ileum. Total colectomy is thought to be curative operation in the patients with ulcerative colitis. However, it must be kept in mind that recurrence can occur in the ileal reservior.