A case of multiple small-intestinal diverticula fraught with ulcer found by melena

症例は70歳代の女性.Hodgkin病および関節リウマチに対して他院にて加療中であった.血液検査にて貧血を指摘されたため,上部･下部消化管内視鏡検査が施行されたが,出血源となる病変は検出されなかった.その後下血が認められたため,小腸出血が疑われ当院へ紹介となった.腹部骨盤造影CT検査では消化管内への造影剤の漏出はなく,空腸に憩室が認められたため,精査目的にて経口的シングルバルーン小腸内視鏡検査が施行された.胃十二指腸および空腸に多発する潰瘍と空腸Treiz靭帯近位に憩室内潰瘍が認められた.ジクロフェナクを常用されており,NSAIDs関連腸管粘膜障害が考えられた.憩室内には腸管内容物が貯留しやすく,高濃度のNSAIDsが憩室内に停滞したことが,憩室内に粗大な潰瘍を形成した要因と考えられた.小腸に憩室が認められる症例に対してはNSAIDsの投与は慎重に行う必要がある.

We report a rare case of multiple duodenal diverticula associated with ulcer accompanied by melena. A 70-year-old level woman undergone treatment for Hodgkin disease. Anemia was revealed by blood examination, but focus of gastrointestinal hemorrhage was not revealed by esophagogastroduodenoscopy and colonoscopy. However, melena was continued and small intestinal hemorrhage was suspected. Extravasation of contrast medium was not seen, but a diverticulum of the jejunum was found on enhanced-CT. Single-balloon endoscopy introduced orally revealed multiple ulcers in the duodenum, jejunum, and ileum and a diverticulum in the jejunum proximal to the ligament of Treitz. Ulcers and ulcer scars were found in the diverticula. Diclofenac sodium was taken habitually and bowel mucosal damage respected to NSAIDs was suspected. Bowel residues retain easily in diverticula and high concentration NSAIDs grew stagnant. That was thought of as cause of wide ulcer. Therefore we have to administer NSAIDs to a case of small-intestine diverticulum.

十二指腸憩室

十二指腸潰瘍

小腸出血