特異な形態および経過を示した小腸多発潰瘍の１例

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  • A CASE OF MULTIPLE ULCERS OF SMALL INTESTINE PRESENTED SPECIFIC MORPHOLOGY AND FOLLOWED PECULIAR COURSE

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We report a case of multiple ulcers of small intestine which presented specific morphology and followed peculiar course.<br> A 48-year-old man was admitted to the hospital because of abdominal pain and bloody stool. There were distension and muscular defence in the entire abdomen. Abdominal CT scan showed dilatation of the small intestine and ascites, and we performed emergency surgery under a suspicion of diffuse peritonitis. Surgical findings included multiple reddened ecchymosis in the small intestine of 60-100cm from the Treitz' ligament and multiple shallow ulcers non-continuously on mesenterium site in the same place. We excised the small intestine by about 50cm in length. Histopathological findings showed prominent bleeding and necrosis in mucosa and submucosal structure angiitis and changes due to circulatory disturbance in small vessels, particularly in venulae. After the operation, he had high fever, bloody stool, diarrhea and abdominal pain after beginning to take meals. These symptoms were improved by administration of elemental diet and oral prednisolone 20mg/day, and he was discharged from the hospital 3 months after the operation. Because histopathological findings showed angiitis of venulae, we searched some small intestinal disease with general angiitis, but were not able to identify another primary disease. The case suggested that micro angiitis might be one of the causes of nonspecific small intestinal ulcer.

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