回盲部に発生した単純性非特異性潰瘍の1例

Non-specific Simple Ulcer in the Ileocecum

　第18回日本消化器病学会秋季大会のシンポジウム「回盲部病変の診断」でも論じられているように，回盲部は消化管のうちでも病変の多い部位の1つでもあり，しかも病変の種類が多く，その質的診断は診断技術の進歩した今日でもなかなかむずかしい．しかし最近では内視鏡の導入により直視下に観察，生検が可能となり，同部位の鑑別診断はだいぶ楽になってきた．われわれはX線検査の段階で単純性非特異性潰瘍と読影し，手術により確診した1例を経験したので若干の文献的考察を加えて報告する．

　Even in the recent years, with advanced diagnostic techniques, the diagnosis of ileocecal lesions is still considerably difficult. We encountered a case in which a nonspecific simple ulcer was found in the radiograph and then definitely diagnosed by operation.

　A 27 year old man attended our hospital complaining mainly of right lower abdominal pain and slight fever. Irregular niche and convergence of mucosal folds were demonstrated in the ileocecum from an ascending irrigoradiograph. However, no longitudinal or girdle niche as well as cobblestone appearance was detected. Additionally, no marked change was found in the follow margin without stenosis. In the fiberscopic examination, no abnormality was noted in the circumferential membrane except for an active ulcer with clear borderline and convergence of mucosal folds. No malignancy was demonstrated in the biopsy findings, as well as necrosis accompanied by ulcer. In the study on resected specimen, a map-like irregular ulcer measuring about 50 mm×40 mm and convergence of mucosal folds were detected. The coecum showed Ul-Ⅳ appearance, and its tunica muscularis was replaced by traces containing lymphocyte, plasma cells and a small quantity of eosinophile infiltrated in the histological examination. A similar inflammatory cellular infiltration of Ul-Ⅲ type was observed in the ileum side. No evidences of granulomatous inflammation, Crohn's disease or tuberculosis were obtained.

　Consideration

　Some considerations were given with respect to the historical background, sex, average age, clinical findings, objective symptoms, diagnosis, site of lesion, number of ulcer, size of ulcer, depth of lesion, perforation rate, recurrence rate, pregnosis and mortality, and recovery of the disease while referring to other literatures.