④特異な経過をたどった回腸末端，結腸の多発性潰瘍の1例

A Case of Unusual Multiple Ulcers of the Terminal Ileum and Colon

　突然の大量下血と高熱で発症し，急性電撃型，全大腸型潰瘍性大腸炎の診断で緊急手術を行ったところ，病理組織学的には全層性の炎症，cobblestone様病変，区域性病変，さらにfissuringなどからクローン病が強く疑われたが，詳細な検索にもかかわらず肉芽腫が証明されず，臨床的にも発病が極めて急性であることの2点からクローン病の確診に至らなかった回腸・結腸の多発性潰瘍の1例を報告する．

　A 45-year-old female who had been acutely ill complained of massive melena and high fever. Though rectal biopsy revealed neither goblet cell depletion nor crypt abscess formation, barium enema showed multiple irregular ulcers along the right side and transverse colon, leading to a diagnosis of acute fulminating ulcerative colitis. Emergency total colectomy and terminal ileal resection were performed by Hartmann's method.

　Macroscopically, there were numerous discontinuous ulcers varying in size, shape, and depth, along the right side, the transverse colon, and the terminal ileum. The intervening mucosa between ulcers was raised up by submucosal edema making cobblestone appearances. Though the ulcers were lined up in two files along the mesenteric and antimesenteric sites of the ileum, typical longitudinal ulceration was not observed.

　Microscopically, transmural inflammation was prominent throughout the colon and ileum. Widening of the submucosa by edema, congestion and lymphatic dilatation was marked. The intervening mucosa was more or less intact and there was neither goblet cell depletion nor crypt abscess. Sarcoid-like granuloma was not identified in any section. Fissuring ulcers were present.

　Clinically, serum immunoglobulins were assessed extraordinarily low and the patient died of sepsis following pulmonary complication and peritonitis.

　Differential diagnosis of idiopathic inflammatory diseases of the bowel including ulcerative colitis was made. However, a definite diagnosis of Crohn's disease could not be obtained.