形態の変化を観察しえた大腸深在性囊胞症の1例

A Histopathological Feature of Colitis Cystica Profunda Changing from Solitary Rectal Ulcer, Report of a Case

要旨　直腸孤立性潰瘍（以下SRU）から大腸深在性囊胞症（以下CCP）への移行を観察しえた症例を経験した．患者は16歳，男性．主訴は下血，排便障害．初回内視鏡検査で直腸に潰瘍を1つ認めた．生検ではfibromuscular obliteration（以下FMO）を認め，SRUと診断した．FFG4の投与と排便指導により主訴は消失した．2回目の内視鏡検査では粘膜下腫蕩の形態を呈していた．局所切除が施行され，病理診断はCCPであった．FMOはほとんど消失していた．SRUの病因を機械的なものとする説や，FMOは機械的刺激によるとする説があることより，CCPへの移行は機械的刺激の消失によると推察された

　We report a case of colitis (orproctitis) cystica profunda changing from a solitary rectal ulcer, in a 16year-old male, He consulted us because of rectal bleeding and disturbance of defecation. On the first endoscopic examination, one ulcer was observed in the rectum (Fig. 1), and its biopsy showed fibromuswlar obliteration (Fig. 2). Therefore he was diagnosed as having a solitary rectal ulcer. After we administered FFG4 to him and forbade him to strain on defecation for a month, his complaints disappeared. The second endoscopic examination showed rectal submucosal tumor (Fig. 3). Local excision of the tumor was performed. Its histopathological diagnosis was colitis cystica profunda, but fibromuscular obliteration had almost disappeared (Fig. 6 and 7). Some of the literature on the point mentioned that the pathogenesis of solitary rectal ulcer was mechanical, and some mentioned that fibromuscular obliteration derived from some mechanical cause. Therefore we think that, in this case, the disappearance of the mechanical agitation upon the ulcer caused its transformation into colitis cystica profunda.