Behçet症候群に起因した回盲部多発性潰瘍

Multiple Ulcers in the Iliocecal Region Caused by Behçet Syndrome

　Behçet症候群は近年わが国に多発する傾向があり，その病状も多彩で難治である上に，青壮年層に罹患者が多いなどの点から社会問題にまで発展するに至った．臨床症状は単にmuco-cutaneo-ocularのみならず全身の炎症性疾患であることも漸次明らかとなり，口腔や会陰部と同様な潰瘍が胃腸管にも発生し，しばしば穿孔をきたして外科的処置を受ける症例が報告されるようになった．今回われわれは，Behçet症候群罹患中に回盲部に興味ある慢性炎症性腫瘤を形成した1例を経験したので報告する．

　Case: A 45-year-old housewife. Chief complaints: a palpable tumor in the right abdomen and full sensation of the belly. Since about 13 years before, aphthae in the mouth, genital ulcer and eruptions in the lower extremities had come and gone repeatedly. As the tumor she had noticed in the iliocecal region since one year before became larger and painful since one month before, she came to see us.

　Including the inflammatory tumor in the iliocecal region, the right half of the colon was resected. The excised specimen revealed many ulcers of varying size in the liocecal region, associated with blind fistulae in most of them. Histologically, ulcers were deep, making a sharp angle with the mucosal surface, and there were outstanding small round cell infiltration in the ulcer walls. Also prominent was a tendency of epithelial regeneration arising out of ulcer margins. It was very characteristic of this case. Vascular changes in the arteries were small, but the veins showed severe phlebitis, presumably responsible for changes in the intestinal tract in our case of Behçet syndrome.

　Six months after the removal of the affected intestinal loop, there was no sign of recurrence. There are many similar reports, and since ulcers are liable to perforate in to the abdominal cavity resulting in peritonitis, more positive attitude should be adopted in the resection of the affected loop.