炎症性ポリープを伴った非特異性多発性小腸潰瘍の1例

A Case of Nonspecific Multiple Small Bowel Ulcer with Inflammatory Polyps

　小腸における潰瘍性病変，特に非特異性潰瘍についてはいまだ不明な点が少なくないが，近年，診断法の進歩に伴い新しい知見が数多く報告されてきた^1)～7)．筆者らは炎症性ポリープを伴う非特異性多発性潰瘍を経験したので報告する．

症例

　患　者：T. M.　65歳　家婦

　主　訴：下腹部痛

　現病歴：昭和33年食後に時々嘔吐あり，某医にて上部小腸に狭窄を認められ約10cmの切除を受けた．術後の経過は良好であったが，約半年後より時々下腹部痛，嘔吐をきたすようになり，再び某医を受診するも異常なしといわれた．腹痛は嘔吐によって軽減し，腹痛発作は年2～3回程度にまで減少したので放置していた．昭和50年5月子宮癌のため本学婦入科に入院し放射線療法を受けた．この治療中に持続性の下腹部痛をきたすようになり当科を紹介された．なお，今回は悪心，嘔吐は認めなかった．

　The patient was a 65-year-old woman with a chief complaint of lower abdominal pain. X-ray films showed multiple stenoses and proximal dilatation in the distal part of the small intestine. Compression of the narrowing part revealed circular niche and a polypoid filling defect. Well-defined ulcers and polyps were found there endoscopically. Biopsy showed no evidence of malignancy or specific inflammation. Cultures of smeared specimens were negative for tubercle bacilli. This case was subjected to surgical exploration under the diagnosis of nonspecific multiple ulcers.

　On opening the intestine, we found 9 stenoses in the ileum between 50 and 170 cm proxima! from the distal end of the ileum, and resected 3 stenosed parts, estimating their severity and sites. Removed specimens presented ulcers that were circular or tended to form rings. In their surroundings, the mucosa with flat sutface lacked Kerkring's valves, where inflammatory polyps were located. There was no picture of longitudinal ulcers or cobble stones. Microscopically, granuloma or marked proliferative changes were not shown with little features indicative of Crohn's disease. The so-called nonspecific multiple chronic ulcer was suggested.

　Inflammatory changes are assumed to have been added to this case because of radiation therapy applied due to her cervical cancer.