ベーチェット病の回盲部にみられた虚血性腸炎の1例

A Case of Ischemic Colitis of the Ileocaecal Region Associated with Behçet's Syndrome

　近年，部分的な血流障害によって生ずる虚血性腸炎が，予後不良な急性腸間膜血管閉塞症とは異なる1つのclinical entityとして注目されている．

　われわれは回盲部に潰瘍病変を認めたベーチェット病患者において，それがいわゆる腸型ベーチェットとしての潰瘍性変化とは異なり，結局は虚血性腸炎であった1例を経験したので，考察を加え報告する．

　A 47-year-old woman was admitted to Hokkaido University Hospital complaining of ulcers of mouth and external genitalia and erythema nodosum. The patient was diagnosed as to have Behçet's syndrome and treated by non-steroid antiphlogistics. About two months later, abdominal pain and bloody stool (about 2,500 ml) occurred. Radiological and endoscopical examinations failed to detect the bleeding site in the gastrointestinal tract. But, soon after, symptoms disappeared without curative therapy. About three months later, abdominal pain and bloody stool occurred again, and a mass was palpable in the right lower quadrant. Barium enema of the colon revealed thumbprinting and pseudotumor in the ascending colon, suggesting ischemic colitis. Operation was immediately performed and revealed the reddened and thickened wall of the ascending colon, which was surgically removed. The resected specimen showed a widely-spread ulcer in the ascending colon and two ulcers in the ileum end. Histological examination showed marked edema in the submucosa, hyaline degeneration, fibrin deposition and thickening of the blood vessel walls, thrombus formation of the blood vessels and infiltration of lymphocytes and neutrophile leucocytes. Soon after, the patient died of recurrence of ulcer.