A CASE OF SIMPLE ULCER IN THE TERMINAL ILEUM PRESUMABLY CAUSED BY DRUG

Abstract

A 41-year-old male was admitted to our hospital with chief complaints of abdominal pain, diarrhea and bloody stool. He had a history of having taken mefenamic acid (Pontal) 1, 500 mg/day for the past three years. Endoscopy revealed a semi-oval ulcer accompanied by the surrounding edema and redness in the terminal ileum. Biopsy specimen taken from the surroundings of the ulcer demonstrated edema in the lamina propria and cell infiltration predominantly consisting of lymph cells. A non-caseating granuloma was found. Double contrast X-ray examination revealed that the small intestine was intact except for the ulcer detected in the terminal ileum. A diagnosis of simple ulcer in the terminal ileum was made. Mefenamic acid was immediately discontinued after admission and salazopyrin was administered from the 39 th hospital day. The ulcer was scarred with concentration of the mucosal folds, leaving redness and a shallow depression. Participation of drug was considered as the cause because the ulcer tended to heal with discontinuation of the drug.