下行結腸に発生した単純性非特異性線状潰瘍

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  • SIMPLE NONSPECIFIC ULCERS (LINEAR TYPE) OF THE DESCENDING COLON

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The patient (A 6960), a 37-year old man, was admitted on August 26, 1974, with a episode of rectal bleeding. He had felt epigastric dull pain and general fatigue for two weeks prior to admission. At the evening of August 23, he had a sudden onset of profuse rectal bleeding after severe vomiting. Since this episode, he had noted sense of distension in the left lower abdomen gradually. There was no previous history of abdominal surgery. On the day of admission, he had experienced of a little amount of rectal bleeding again but had no more those episodes during hospitalization. The WBC count was 11000 and ESR was 30mm in one hour. The first barium enema examination (Fig. 1) showed localized area of narrowing with irregularity of the mucosal pattern in the lower portion of the descending colon, and the 2nd examination (Fig.2) showed persistent 3 linear ulcer scars and several deverticula-like deformities at the same area. Colonofiberscopic examination (Fig.3) revealed the ulcer scar, uneveness and bleeding of the mucosa and narrowing of the lumen immediately proximal to the ulcer scar. A minimal resection of the descending colon with end-to-end anastomosis was done with clinical diagnosis of benign ulcers of the colon. On opening the specimen 4 linear ulcer scars were seen side by side, each measuring 4.4cm, 4.1cm, 3.2cm and 2.2cm in length, separated by intact mucosa (Fig.4). Microscopically, the ulcer remained superficial or submucosal layer and there was a very marked fibrotic tissue beneath it with a mild chronic inflammaroty reaction (Fig.5). The diagnosis was simple nonspecific ulcers of unknown cause. There has been no recurrence of bleeding in more than 17 months of follow-up. Clinical symptoms and pathological findings in the literature were reviewed and some discussions were made.

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