特異な進展を示した区域性潰瘍性大腸炎の1例

Segmental Ulcerative Colitis Developing in an Unusual Form, Report of a Case

要旨　患者は81歳の男性．大腸炎の既往はなく，半年前から出現した粘血便が増悪し入院．初回内視鏡検査で，直腸にはびまん性全周性の樹枝状潰瘍像，脾彎曲部には偏在する浅い潰瘍像，肝彎曲部には散在する島状の発赤粘膜面を認めた．介在粘膜は正常で，潰瘍辺縁には点状びらんが散在していた．salazosulfapyridine，抗菌剤，中心静脈栄養，抗結核療法を行ったが病変は片側性に融合拡大し，区域性の管状狭窄像を呈した．最終的にはprednisoloneが著効し緩解像が得られたが，半年後肺炎のため死亡した．剖検大腸の検索では潰瘍性大腸炎に矛盾しない組織像であり，特異な進展様式を示した区域性潰瘍性大腸炎と考えられた．

　An 81-year-old man was admitted to our hospital with the complaint of mucobloody stool for six months. Colonoscopy showed diffuse shallow ulcers in the rectum, which resembled features of ulcerative colitis in the active phase. There were superficial ulcers in the proximal descending colon and multiple spotty erosions surrounded by normal colonic mucosa in the transverse colon. Three months later, these lesions spread longitudinally and developed into diffuse mucosal ulcerations with luminal narrowing. Intravenous administration of prednisolone 30 mg per day was remarkably effective, but, the patient died of pneumonia six months later. Histological features of the colon at autopsy were consistent with the quiescent phase of ulcerative colitis, although distribution of colonic inflammation was segmental.