INTESTINE Vol.18 No.4(8)


特集名 日常遭遇する大腸炎の鑑別─内視鏡を中心に
題名 エルシニア腸炎
発刊年月 2014年 07月
著者 清水 誠治 大阪鉄道病院消化器内科
著者 三上 栄 神戸市立医療センター西市民病院消化器内科
著者 石田 哲士 大阪鉄道病院消化器内科
著者 横溝 千尋 大阪鉄道病院消化器内科
著者 森 敬弘 大阪鉄道病院消化器内科
著者 富岡 秀夫 大阪鉄道病院消化器内科
【 要旨 】 エルシニア腸炎はYersinia enterocolitica,またはY. pseudotuberculosisの腸管感染であり,病変は回盲部に好発する.菌の特性から培養での検出が難しい.特徴的な内視鏡所見はリンパ濾胞やパイエル板の腫大とびらんであり,時に敷石像類似の所見を呈する.その場合クローン病との鑑別点は,エルシニア腸炎では隆起の頂部にびらんがみられるのに対し,クローン病では隆起間に潰瘍がみられる点である.エルシニア腸炎の生検組織で非乾酪性類上皮細胞肉芽腫がみられることがある点にも注意が必要である.
Theme Differential diagnosis for common enterocolitis, especially in endoscopic findings
Title Yersinia enterocolitis
Author Seiji Shimizu Division of Gastroenterology and Hepatology, Osaka General Hospital of West Japan Railway Company
Author Sakae Mikami Department of Gastroenterology, Kobe City Hospital Organization Kobe City Medical Center West Hospital
Author Tetsushi Ishida Division of Gastroenterology and Hepatology, Osaka General Hospital of West Japan Railway Company
Author Chihiro Yokomizo Division of Gastroenterology and Hepatology, Osaka General Hospital of West Japan Railway Company
Author Takahiro Mori Division of Gastroenterology and Hepatology, Osaka General Hospital of West Japan Railway Company
Author Hideo Tomioka Division of Gastroenterology and Hepatology, Osaka General Hospital of West Japan Railway Company
[ Summary ] Yersinia enterocolitis, which is caused by Yersinia enterocolitica or Y. pseudotuberculosis, involves the ileocecal region in most cases. Demonstration of Yersinia through cultures is difficult due to its bacteriological features. Characteristic endoscopic features include swelling of lymph follicles and Peyer's patches accompanied by erosions. Differential diagnosis with Crohn's disease becomes a problem when cobblestone-like appearance is observed in Yersinia enterocolitis. Points of discrimination include erosions on prominences seen with Yersinia enterocolitis and ulcers between those observed with Crohn's disease. It should be also remembered that non-caseating epithelioid granulomas may be demonstrated in biopsy specimens taken from patients with Yersinia enterocolitis.
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