非特異性多発性小腸潰瘍症の1例

Nonspecific Multiple Ulcers of the Small Intestine: Report of a case

　非特異性多発性小腸潰瘍症は，その特異的な臨床像および病理像より，岡部，崎村が提唱した名称である．すなわち，臨床像は長期にわたる腸管からの出血と，これに基づく貧血，低蛋白血症を主徴とし，病理学的には回腸中部から下部の輪走または斜走するUl-Ⅰ～Ⅱの多発性潰瘍である．われわれは最近，典型的な本症を経験し，新たに術中内視鏡検査，局所線維素溶解現象（局所線溶）の測定を行なったので，若干の文献的考察を加え報告する．

　A 38-year-old female patient, complaining of anemia and edema, was admitted to Kyushu University Hospital in April 1974.

　She had hypochromic anemia and hypoproteinemia (TP: 4.6g/dl). Repeated stool examinations for occult blood were always strongly positive. Mantoux's reaction was questionably positive. X-ray examinations showed multiple focal rigidity with some areas of mild convergence of the mucosal folds in the lower part of small intestine.

　In July 1974, a partial resection of the ileum was performed under the endoscopic examination through ileostoma by confirming the location of the ulcers. The resected specimen showed 32 shallow annular ulcers without conspicuous contraction surrounded by almost normal mucosa.

　Histologically, all ulcers were shallow and revealed slight fibrosis and infiltration of lymphocytes and plasma cells localized in the ulcerated area. There were no granulomatous lesions with giant cells in the wall or regional lymphnodes, marked edema or fissure.

　Tissue fibrinolysis was examined by fibrin plate method. The fibrinolytic activity was increased in the ulcerated area, when compared with that in the normal area of ileum of the same patient. Since the occult blood of her stool became strongly positive again one month after the operation, administration of t-AM CHA was started but it was ineffective.