炎症性腸疾患の画像所見と鑑別診断—打ち抜き様潰瘍（多発/単発）

Punched-out Ulcers

要旨●“打ち抜き様潰瘍”とは境界明瞭で断崖状に下掘れする潰瘍の呼称である．打ち抜き様潰瘍を呈する代表的な消化管の炎症性疾患としては，腸管Behçet病，単純性潰瘍，サイトメガロウイルス感染症が挙げられる．Crohn病，潰瘍性大腸炎，trisomy 8に伴う腸病変，NSAIDs起因性腸炎などでも多彩な内視鏡所見の一つとして認められる．これらの疾患を内視鏡所見のみで鑑別することは困難であるが，特徴的な内視鏡所見に基づいて横断的に理解することは多岐にわたる炎症性腸疾患の鑑別診断を行う上で有用である．

　A punched-out ulcer is recognized as a deep ulcer with well-defined, cliff-like margins. Diseases and disorders symptomized by these ulcers include Behçet's disease, Crohn's disease, ulcerative colitis, cytomegalovirus gastroenteritis, NSAIDs-induced enteritis, and Trisomy 8.

　Additionally, simple ulcers may also have a punched-out appearance. Relying purely on endoscopic findings, it can be challenging for practitioners to distinguish between the aforementioned conditions ; however, cross-sectional data on their unique characteristics have proven useful in determining diagnoses. In this article, we review diseases that present with punched-out ulcers and discuss their key features as a means to improve upon current assessments and therapies.