湯浅 肇¹, 広岡 大司², 井出 満², 尾崎 一¹, 斉藤 博¹, 多々見 光仁¹, 柳瀬 賢次¹, 吉村 誠¹, 綿引 元¹

Hajime YUASA¹, Takashi HIROOKA², Mitsuru IDE², Hajime OZAKI¹, Hiroshi SAITO¹, Mitsuhito TATAMI¹, Kenji YANASE¹, Makoto YOSHIMURA¹, Hajime WATABIKI¹

¹聖隷三方原病院, ²岸和田徳州会病院

¹Seirei Mikatabara Hospital, ²Kishiwada Tokushukai Hospital

キーワード : Ultrasonic findings, Terminal lleitis, Yersima Enterocolitica

Terminal ileitis has been found unexpectedly during the operation under the preoperative diagnosis of appendicitis in many cases because of its difficulty to differentiate from appendicitis by physical examination, but we found that the ultrasonography is useful for the diagnosis of ileocecal disease.
Especially ultrasonogram of terminal ileitis by Yersinia is relatively specific and useful for its diagnosis and the follow-up survey.
The specific findings of terminal ileitis caused by Yersinia are as follows. 1) Longitudinal scan shows the marked thickening of the terminal ileal wall and nodular low echo areas in the wall, which are considered as the swollen and proliferated Peyer's patches and lymphatic nodules. 2) The transvers scan shows low echo nodules in thickening mucosa, which is surrounded by thickening submucosa, then muscular layer and swelling subserosa and serosa, which is just looks like an axle. 3) Bauhin's valve is mildly swollen. 4) Several regional lymph nodes are markedly swollen. With these　findings we consider that pathophysiologically the primary inflammation of terminal ileitis by Yersinia is located in Peyer's patches and lymphatic follicles, which extends to regional lymph nodes and then involves the intestinal wall and mesenterium near by.