Backwash ileitis による回腸穿孔を来した潰瘍性大腸炎の1例

A case of ileal perforation due to ulcerative colitis with backwash ileitis Satoki Kojima , Shinjiro Mori , Eiji Nakamura , Norio Yamashita 1 Shigeki Hikida , Teruo Sakamoto , Junya Masuda 2 1 Department of Emergency and Critical Care Medicine, Kurume University School of Medicine 2 Department of Gastroenterology, Nagata Hospital Ulcerative colitis (UC) is an inflammatory bowel disease. One of the features of UC is that the inflammation is localized in the colorectum. The inflammation, however, can spread past the ileocecal valve, a condition called backwash ileitis (BI). It is rare to observe the end of the ileum by endoscopy during the aggravation phase in severe UC. The initial diagnosis of BI often occurs during surgery. In this report, we present the case of a 26-year-old male who had been diagnosed with UC seven years previously. Once it became severe, he was treated with a steroid. He eventually developed panperitonitis due to intestinal perforation. Because there were multiple perforations of the ileum, a partial excision of the small intestine was performed. A second procedure, a total colectomy, was performed after the patient developed melena. Upon pathological inspection, a characteristic of UC was found in the excised ileum. Ileal perforation as a result of severe UC combined with BI is very rare. The treatment in a case such as this, for peritonitis caused by ileal perforation as a result of BI, is limited to the partial excision of the small intestine, which preserves the colon. However, it seems that a total colectomy should have been performed, considering that the postoperative melena of the colon had continued. (JJAAM. 2013; 24: 99-104)