薬剤性小腸潰瘍による大量出血の1例

NSAIDs-lnduced Massive Hemorrhagic Small Intestinal Ulcers, Report of a Case.

要旨　非ステロイド性抗炎症剤（NSAIDs）による出血性小腸大腸潰瘍の1例を報告する．患者は68歳，男性．15年前より慢性関節リウマチで経過観察されていた．転倒打撲に対し，Indomethacin坐薬（100～150mg），Pronoprofen（225mg/day）を18日間投与された後，大量の下血で発症．術中内視鏡所見では回腸～空腸の広範囲にほぼ円形の多発潰瘍を認めた．潰瘍は腸間膜反対側に分布し，多くはUl-Ⅱの浅い潰瘍で打ち抜き状を呈し，正常粘膜との境界は明瞭であった．NSAIDs起因性小腸潰瘍の診断基準はいまだ明らかではないが，臨床経過，病理組織所見などからNSAIDsに起因する小腸潰瘍の典型例と考えられる．

　A 68-year-old man with rheumatoid arthritis was admitted to Kitasato University East Hospital because of massive melena. He had had indomethacin suppositorium (100～150 mg/day) and pronoprofen (225 mg/day) for his lumbago and arthritis during 18 days after blow. Endoscopic examinations showed multiple hemorrhagic punched-out ulcers in the terminal ileum to the upper jejunum. Surgical specimen revealed multiple ulcers distributed at the anti-mesenteric site in the small intestine. The lesions were punched-out shaped with surrounding normal mucosa. Histology of the typical ulcer was Ul-Ⅱ type with a predominantly acute inflammatory reaction in the ulcer bed. No granulomata, vascular change, or amyloidosis were seen in any part of the small intestine.

　Non-steroidal antiinflammatory drugs (NSAIDs) may lead to small bowel ulceration.