再発を繰り返した分類不能の腸潰瘍の1例

Recurrent Unclassified Ulcer of the Colon and Terminal Ileum, Report of a Case

要旨　患者は44歳，女性．1991年6月微熱，下痢傾向，左下腹部痛を主訴に来院．初診時，注腸X線検査および大腸内視鏡検査で，直腸‐S状結腸に縦走潰瘍を認めた．潰瘍の増悪，強いとう痛のため，直腸切除を施行．病理組織学的には特異的な所見を認めなかった．術後，とう痛は消失していたが約1か月半後，吻合部近傍に潰瘍の再発を認め，再びとう痛が出現し，増強してきたため，2回目の手術（直腸‐S状結腸切除術）を施行した．人工肛門の口側に再び潰瘍の発生を認め，腸管穿孔を起こしたために3回目（S状結腸，下行結腸切除術），4回目（横行結腸，下行結腸，盲腸切除術）の手術を施行したが，いずれの切除標本の病理組織学的検索でも特異的な所見を認めないこと，現在までのところ同様の経過をとった症例の報告はないことから，分類不能の腸潰瘍と診断し，報告した．治療として，ステロイド剤，elemental diet療法，絶食，高カロリー輸液などを行ったが，無効であった．1994年8月には，内視鏡検査で回腸末端に潰瘍の再発を認めており，治療に難渋している．

　The patient was a 44-year-old woman who visited our hospital in June, 1991 because of low grade fever, diarrhea, and left lower abdominal pain. Ba-enema and colonoscopy revealed liner ulceration of the rectosigmoid area. Lower anterior resection was carried out because of enlargement of the ulceration and severe abdominal pain. Histo-pathological examination showed non-specific findings and the lesion was diagnosed as unclassified ulcer. Postoperatively, pain disappeared, but one month and a half after the operation, ulcer recurred in the anastomotic area and the severe pain reappeared. The second operation (resection of the rectum and the sigmoid colon) was performed because of the severe pain. The third operation (resection of sigmoid and descending colon) and the fourth operation (resection of the transverse and ascending colon, and cecum) was done because of perforation by the recurring ulceration at the oral side of the artificial anus. Histologically, all the resected specimens were diagnosed as unclassified ulcers. Two months after the fourth operation, endoscopy revealed recurrence of the ulceration in the terminal ileum. Neither steroid nor alimental diet therapy, nor intra-venous hyperalimentation were effective for ulcer healing and relief of abdominal pain.