縦走潰瘍・血管炎・肉芽腫を伴った腸結核疑診例の1例

Suspected to be Intestinal Tuberculosis with Findings of Longitudinal Ulcers, Vasculitis and Granulomas, Report of a Case

要旨　症例は69歳，男性．下血を主訴に入院．大腸検査にて右半結腸に多発潰瘍を認め，経腸栄養療法を施行するも改善乏しく，当科転院となる．大腸検査所見では，病変は主として盲腸と上行結腸にみられた．すなわちBauhin弁の開大，萎縮瘢痕帯，3条の縦走傾向の潰瘍とfissuring ulcerを認めた．横行結腸にもskipして縦走潰瘍がみられた．栄養療法を施行するも病変の改善を認めなかったため，右半結腸切除術を施行した．摘出標本の病理組織学像では，回盲部から上行結腸にかけての潰瘍，全層性炎症，裂孔，比較的大型の非乾酪性類上皮細胞肉芽腫がみられ，動静脈に血管炎を伴っていた．術後再発は9年間認めていない．本症例は，縦走潰瘍を認め，結核の確診はできなかったものの，臨床上，また病理組織学的に，腸結核が強く疑われる症例と考えられる．

　A 69-year-old man was admitted to a hospital because of hematochezia. Colonic X-ray and colonoscopy revealed multiple ulcers in the ascending colon. The patients was referred to our hospital because of his constitutional resistance towards enteral nutrition therapy. At the colonic examination, lesions were mainly seen in the cecum and the ascending colon. The findings were : opening of the ileocecal valve, a mucosal atrophic zone and three longitudinal ulcers and fissuring ulcers. In the transverse colon, longitudinal ulcers were also found sporadically. Surgical right hemicolectomy was performed because of the resistance to nuturitional therapy. Histopathological findings of the resected specimens, showed that multiple ulcers from the cecum to the ascending colon, inflammation of whole layer, fissure, a relatively large non caseating granuloma with vasculitis around the arteries and veins. No recurrence of colitis has been found in this case for these nine years. Clinically and histopathologically, this case was highly suspected to have intestinal tuberculosis despite the findings of longitudinal ulcers, however, definite diagnosis of tuberculosis was not made because of negative bacterial existence.