非特異性多発性大腸潰瘍の1例

Nonspecific and Multiple Ulcer of the Colon In a Chronic Hemodialysis Patient, Report of a Case

要旨　患者は41歳男性で，慢性糸球体腎炎のため約10年前より，週3回の血液透析を受けていたが，下腹部痛のため来院した．注腸X線検査および大腸内視鏡検査にて，上行結腸に2個の全周性潰瘍と横行結腸に1個の小潰瘍を認めた．生検ならびに切除標本の病理組織学的検査にて，非特異性大腸潰瘍と診断したが，潰瘍底にサイトメガロウイルスによる核内封入体を認め，潰瘍形成とサイトメガロウイルス感染の関連が示唆された．また，腎不全患者あるいは腎移植後患者に発生した非特異性大腸潰瘍は極めてまれであり，若干の文献的考察を加えて報告した．

　A 41 year-old man was admitted complaining of pain in the lower abdomen. He had been on chronic maintenance hemodialysis three times every week for ten years because of chronic glomerulo-nephritis. Barium enema study and colonofiberscopy showed two ulcers at the ascending colon and a small ulcer at the transverse colon. Histological examination of the biopsy and resected specimens revealed nonspecific ulcer of the colon and cytomegalovirus inclusion could be seen at the bottom of the ulcers.

　Gastrointestinal bleeding in renal failure or renal transplant patients is observed occasionally but nonspecific ulcer of the colon is very rare and only fifteen cases including this case have been reported in the world medical literature. In this report, the clinical features of the fifteen cases and the relationship between cytomegalovirus infection and colonic ulcer were discussed.