回盲部の単純性潰瘍で手術を受け11年後に吻合部近傍に多発性小潰瘍を認めた1例

Nonspecific Ulcer of the Ileocecal Region Recurring 11 Years after Surgery, Report of a Case

要旨　患者は69歳（初診時58歳）女性．下血および右下腹部痛を主訴に来院し，小腸二重造影で回腸終末部の変形および多発潰瘍を認めた．腸結核が疑われ抗結核療法を施行したが反応せず症状の改善がみられないため，回盲部切除が施行された．術後の病理診断で非特異性単純性潰瘍と診断された．経過観察中，術後2年，11年後に注腸造影，大腸内視鏡で吻合部近傍に多発性潰瘍の再発が確認された．本症例は初診から11年の経過中アフタ性口内炎がしばしばみられたものの，このほかにはBehçet病の診断基準にみられる症状は出現せずに“疑わしい型”にとどまり，境界病変の経過例として興味深いので報告した．

　A 69-year-old woman was admitted with the complaint of anal bleeding. Gastrointestinal work-up was performed and ulcers and deformity of the ileocecal region were detected. We suspected intestinal tuberculosis and performed ileocecal resection. Postoperative pathological diagnosis was nonspecific ulcers of the ileocecal region. Two years later and, then, 11 years later, using barium enema and endoscope, we detected recurrent ulcers near the anastomosis.

　During an eleven-year period follow-up, she has occasionally developed recurrent aphthous ulcerations in the mouth. But she has never had any other signs of Behçet's disease.