Hideki Kito

A CASE OF NON-SPECIFIC MULTIPLE ULCER OF THE SMALL INTESTINE

症例は, 23歳,女性.平成11年,十二指腸潰瘍穿通にて広範囲胃切除術施行された.同年,癒着性イレウスの診断にて,癒着剥離術を施行した.この際,回腸末端部より約80cm付近に8カ所の輪状の壁肥厚を認めたため一部を切除した.肥厚部にはびらんを認め,病理学的には非特異的炎症所見のみであった.平成14年8月,突然の下腹部痛が出現し,外来を受診した.受診時,下腹部に強い圧痛を認めたが腹膜刺激症状は認めなかった.腹部CTで小腸の拡張とTargetsign様の所見を認めたため,腸重積を疑い緊急手術を施行した.回腸末端部に8カ所の壁肥厚を認め,それより口側の腸管の拡張を認めたため同部を切除した.切除標本では輪状の潰瘍瘢痕様の病変を8カ所に認め,病理学的には浅い潰瘍形成と粘膜下層の非特異的炎症像が認められ非特異的多発性小腸潰瘍症と診断した.

A CASE REPORT OF JUVENILE MULTIPLE COLO-RECTAL POLYPS WITH PROTEIN LOSING GASTROENTEROPATHY

A 14-year-old girl was admitted to the hospital because of watery diarrhea and edema of the lower extremities. Barium enema and endoscopy of the large intestine revealed multiple colorectal polyps with a circumferential IIa. group-like elevated lesion at the rectum. Leakage of isotopes from the rectum to the sigmoid colon was proved on 99mTc-HSA scintigram, and marked hypoproteinemia (TP 3.7g/dl), low level of IgG and increase in α1-antitrypsin clearance were recognized. From the above findings a diagnosis of multiple cold-rectal polyps with protein losing gastroenteropathy was made. Although the intestinal lesion in this patient was a tubular adenoma with slight atypia, it was a so-called IIagroup-like lesion macroscopically, assuming a form whose canceration rate is called high, and was complicated with protein losing gastroenteropathy. And hence proctosigmoidectomy was performed though the patient was young. This paper describes this case together with some literature discussion.