小腸内視鏡で診断しえた出血性多発性空腸潰瘍の1例

Hemorrhagic Multiple Jejunal Ulcers Diagnosed by Small Intestinal Fiberscope, Report of a Case

要旨　患者は57歳，男性．7年にわたる原因不明の慢性の下痢と下血を主訴に来院した．上部・下部消化管内視鏡検査では異常を認めなかったが，プッシュ式小腸内視鏡検査でTreitz靱帯近傍から肛門側50cmまでの上部空腸に多発性の小潰瘍が認められ，出血源と考えられた．TPNを約1か月施行したところ潰瘍は瘢痕化し，その後も再発は認めていない．形態学的に本症例に類似した症例は降圧剤の服用歴を有する2例が報告されているにすぎない．本例は病歴，好酸球増多などからメフェナム酸(Pontal^®)服用との関連が疑われた．内視鏡およびX線検査で描出された小腸の微細病変の報告は少なく，貴重な症例と考え報告した．

　A 57-year-old male was admitted to our hospital complaining of diarrhea and melena. The gastrointestinal endoscopy and total colonoscopy showed no evident lesion. The push-type small intestinal fiberscope demonstrated multiple small active ulcers on Kerckring's folds in the upper jejunum. Examination of the biopsy specimen from these lesions showed only mild nonspecific inflammation. Initial double-contrast study of the small intestine showed no abnormality, but repeated study revealed a few small active ulcers in the upper jejunum. After a four-week course of total parenteral nutritional therapy, the jejunal ulcers healed and the patient's symptoms improved. The clinical features, x-ray and endoscopic findings, histological examination and clinical course of this case were not compatible with any established disease of the small bowel.

　The patient's history and blood examination suggested that these hemorrhagic ulcers might be caused by continuous usage of mefenamic acid.