肉芽腫を認める下部消化管疾患

Lower Gastrointestinal Disease with Granuloma

要旨●肉芽腫を認める感染性腸炎について述べた．腸結核とエルシニア腸炎の自験例について，臨床像と内視鏡像を検討し，チフス性疾患については症例を提示した．生検組織で疾患特異的な肉芽腫がみられることは少なく，臨床像，内視鏡像による鑑別診断が重要である．腸結核では無症状例が最も多い．特徴的な内視鏡像は，輪状潰瘍あるいは輪状配列する潰瘍，多発潰瘍瘢痕と活動性潰瘍の併存，発赤を伴う樹枝状不整形潰瘍，敷石像様所見である．エルシニア腸炎の臨床症状は腹痛と発熱が主である．特徴的な内視鏡像は終末回腸の小びらんを伴う腫大したPeyer板，腫大した回盲弁，終末回腸〜上行結腸のアフタである．

　We examined our cases of intestinal tuberculosis and Yersinia enterocolitis in terms of clinical features, endoscopic characteristics, and differential diagnoses. Moreover, we present a case of paratyphoid enterocolitis. Clinical features and endoscopic findings are important for differential diagcosis of these disease, because these diseases specific granuloma have not been almost obtained from the biopsy specimens. In total, 57% of our intestinal tuberculosis cases were asymptomatic. Endoscopic characteristics of intestinal tuberculosis include the following：circular or circularly-arranged ulcers, coexistence of multiple ulcer scars and active ulcers, irregular arborescent ulcers with redness, and a cobblestone-like appearance. The main symptoms of Yersinia enterocolitis are abdominal pain and fever. Endoscopic characteristics of Yersinia enterocolitis include swelling of Peyer's patches with small erosions, swelling of the ileocecal valve, and aphthoid ulcers extending from the terminal ileum to the ascending colon.