大腸にアフタ様病変の出現消退を繰り返し，8年後終末回腸に縦走潰瘍が出現した肛門周囲膿瘍を伴うCrohn病の1例

Crohn's Disease Showing Diffuse Aphthoid Lesions and Their Sequential Changes over Thirteen Years, Report of a Case

要旨　患者は17歳，男性．肛門周囲膿瘍と体重減少を主訴に来院．下部消化管内視鏡検査で，終末回腸と全大腸に多発，密集するアフタ様病変を認めた．生検にて非乾酪性肉芽腫が証明され，Crohn病と診断した．salazosulfapyridine（SASP）と経腸栄養法にて，内視鏡上アフタ様病変のみとして経過したが，8年後，終末回腸に縦走潰瘍が出現．その後，肛門周囲膿瘍，痔瘻の増悪がみられ，人工肛門を造設した．大腸はアフタ様病変のまま13年間経過観察中である．

　A 17-year-old male was admitted to our hospital with complaints of perianal abscess and body weight loss. Colonoscopy showed diffuse aphthoid lesions throughout the terminal ileum and entire colon. Non-caseating epithelioid cell granulomas were detected in the biopsy specimens taken from the aphthoid lesions, and we diagnosed this patient as suffering from Crohn's disease. The patient was treated with SASP and elemental diet alimentation. Eight years later, typical cobblestone appearance developed in the terminal ileum. Furthermore, the recurrence of perianal abscess appeared. However, the aphthoid lesions in the colon persisted unchanged for the total follow-up period of thirteen years.