ダブルバルーン小腸内視鏡にて病変を観察しえた非特異性多発性小腸潰瘍症の1例

Chronic Nonspecific Multiple Ulcers of the Small Intestine Observed by Double-Balloon Enteroscopy, Report of a Case

要旨　患者は26歳，男性．1歳時より難治性鉄欠乏性貧血，低蛋白血症を認め，18歳時に小腸型Crohn病と診断されていた．高度な貧血を認め，当センター入院となった．小腸X線造影検査では，中部小腸に非対称性の変形・狭窄が多発し，地図状のバリウム斑を認めた．小腸内視鏡検査では，ひだ集中を伴う境界明瞭な浅い類円形潰瘍，非同心円状の全周性潰瘍，斜走する潰瘍を認めた．小腸切除標本では，境界明瞭で平坦な輪走・斜走する地図状・テープ状の潰瘍が多発し，大部分がUl-IIまでの非特異的潰瘍または瘢痕であった．以上より，自験例は特徴的な臨床経過，X線造影・内視鏡所見，切除標本の肉眼・組織学的所見から非特異性多発性小腸潰瘍症と診断した．

　A 26-year-old male was admitted to our institution on account of anemia, edema of the lower extremities, and abdominal pain. He had a long history of refractory iron deficiency anemia and hypoproteinemia and he had been diagnosed with Crohn's disease when he was 18 years old. Small bowel radiography showed multiple bilateral or eccentric deformities and stenoses in the ileum. Antegrade double-balloon enteroscopy showed shallow and sharply demarcated circular, linear, and oblique ulcers in the ileum. Macroscopic inspection of the resected ileum showed sharply demarcated linear and geographic ulcers arranged in a circular or oblique manner. Histologically, the multiple ulcers and scars were restricted to the submucosal layer with minimal inflammatory infiltrates and fibrosis. Based on these findings, we diagnosed this case as chronic nonspecific multiple ulcers of the small intestine.