回盲弁より40cm口側に発生した単純性潰瘍の1例

Simple Ulcer of the Ileum at 40 cm Oral from the Bauhin's Valve, Report of a Case

要旨　患者は36歳の男性で，主訴は臍下部痛であった．来院3か月前より持続的な鈍痛を覚えるようになり，近医で胃X線検査，大腸X線検査，腹部エコーなどが行われたが異常はみられなかった．症状増悪のため当科に紹介入院となった．小腸X線検査で，回盲弁から約40cm口側に幅2.5cmの著明な狭窄がみられ．周堤形成，縦長潰瘍の存在も疑われた．切除標本では，大きさ3.5×2.0cmの境界明瞭な下掘れ潰瘍が腸間膜付着側に存在し，周辺の膨隆もみられた．しかし，縦走潰瘍は存在しなかった．組織学的には潰瘍はUl-Ⅳであり，線維性結合組織の増生により腸管壁は著しく肥厚していた．病理学的診断は単純性潰瘍であった．自験例の潰瘍はまれな部位に発生したことから術前に小腸癌，Crohn病との鑑別を要した．

　The patient was a 36-year-old male with a complaint of continuous dull pain under the umbilicus for the last 3 months. He had undergone an upper GI series, a barium enema and an abdominal US at another hospital and was told that no abnormal findings were noted. He was referred to our hospital because of increasing abdominal pain. A small intestinal roentgenography at our hospital demonstrated a severe stenosis, 2.5 cm in length, at about 40 cm oral from the Bauhin's valve. Coexisting longitudinal ulcer and marginal elevations were also suspected (Figs. 1-3).

　Examination of the resected specimen showed a deep and clearly demarcated ulcer, 3.5×2.0 cm in size, on the mesenteric side with marginal elevations but without a longitudinal ulcer (Fig. 5). Histologically, the depth of this ulcer was Ul-Ⅳ and the small intestinal wall was markedly thickened because of the proliferation of fibrous tissue (Fig. 6). Based on these findings this lesion was diagnosed to be a simple ulcer in the ileum.

　It would be relatively unusual that a simple ulcer occurs in the ileum. Therefore, it was necessary to differentiate it from adenocarcinoma or Crohn's disease before the operation.