下血を来した分類困難な微小な多発性空腸潰瘍の1例

Unclassifiable Multiple Jejunal Ulcers with Melena, Report of a Case

要旨　患者は62歳，男性．突然の下血，上腹部不快感を主訴に来院した．入院時検査成績上，貧血があり，便潜血強陽性であったが，炎症所見は陰性であった．上部・下部消化管内視鏡検査では出血源を認めなかった．第2病日の経口小腸検査にて上部空腸に限局性の軽い浮腫像が見られ，プッシュ式小腸内視鏡検査にて多発性小潰瘍が確認された．臨床経過は良好で発症5日目には下血は消失し，以後約2年間の経過観察を行っているが再発はみられない．臨床像，X線・内視鏡所見，臨床経過および生検組織の検討では，既知の疾患との共通点は少なく，分類困難な小腸潰瘍と考えられた．

　A 62-year-old male was admitted to our hospital complaining of melena and epigastric discomfort. The upper and lower gastrointestinal series showed no evident lesion. Then small bowel follow-through examination was performed, and revealed mild edematous Kerckring's folds of the upper jejunum. The push-type small intestinal fiberscope demonstrated some small depressed lesions on the Kerckring's folds and microconvergence in the upper jejunum. Examination of the biopsy specimen from these lesions showed only mild non-specific inflammation. The clinical course was fair and, after discharge, clinical recurrence has not been observed for two years. The clinical features, x-ray and endoscopic findings, histological examination and clinical course of this case were not compatible with any already identified disease of the bowel. Therefore this case seemed to be one of “unclassifiable ulcer of the small intestine”.