回盲弁上の単発小潰瘍から典型像への自然経過を観察できた大腸結核の1例

Colonic Tuberculosis on the Ileocecal Valve, Which Developed from a Small Ulcerative Lesion to an Annular Stricture in Two Years, Report of a Case

要旨　患者は38歳，男性．約2年前から下痢気味であったが鮮血便が出現し来院．大腸X線・内視鏡検査で回盲弁に約1cm大の不整陥凹を認め，生検で類上皮性肉芽腫を認めたが確定診断に至らず，経過観察となった．8か月後には主病変に変化はなかったが，回盲弁対側に新たに浅い陥凹性病変を認めた．1年10か月後には，回盲弁上の潰瘍は腸の横軸方向に進展し，白苔が明瞭化した．回盲弁対側の潰瘍も増大し，深さも増した．3年9か月後には，回盲弁上の潰瘍は不整地図状となり，対側の潰瘍と連なって輪状に狭窄していた．生検で再度肉芽腫を確認でき，腸結核と診断．6か月間の抗結核剤3剤併用療法により潰瘍は瘢痕化し，肉芽腫も消失した．

　A 38-year-old man visited our hospital with his chief complaints being soft stool and fresh anal bleeding. Endoscopy and barium-enema on Apr. 1992 revealed an irregular-shaped ulcerative lesion, about 1 cm in size, located on the ileocecal valve. Biopsy specimen showed epithelioid granulomas and giant cells, but we could not definitely diagnose this legion as tuberculoid and followed it up carefully. In Dec. 1992, the ulcerative lesion on the ileocecal valve had not changed in size or shape, but a new shallow ulcerative lesion of small size had appeared at the cecum opposite the ileocecal valve. In Feb. 1994, the ulcerative lesion on the valve had grown in size in a horizontal direction and had deepened. The ulcerative lesion opposite had also grown in size and in depth. In Jan. 1996, the enlarged ulcers on and opposite the ileocecal valve had developed and formed an annular stricture. In addition, the biopsy specimen showed epithelioid granulomas and Langhans' giant cells, so that we diagnosed colonic tuberculosis. After medication of triple anti-tuberculous drugs (RFP, INH, and EB) for six months, the ulcers on and opposite the ileocecal valve remained as lesion scars, but the annular stricture was unchanged.