非定型的Crohn病の診断と経過―X線，内視鏡所見を中心に

Diagnosis and Follow-up Study about Crohn's Disease Presenting with Findings of Ulcerative Colitis

要旨　当院のCrohn病（以下CD）311例中潰瘍性大腸炎に類似した所見（UC類似病変）を合併した非定型例は6例（1.9％）であった．UC類似病変が初回検査時に認められた症例は4例（67％）で，経過中に出現してきた症例は2例（33％）であり，CD発症後7年と9年であった．直腸にUC類似病変を認めたものは3例（50％）であり，病変が非連続性で区域性であったのは2例（33％）であった．UC類似病変がCD典型例へ進展したのは2例（33％）で，UC類似病変出現後3年と8年であった．CDのUC類似病変合併例の診断には肛門部病変や小腸病変の有無と，病変部以外の部位からも非乾酪壊死性類上皮細胞肉芽腫の検出を試みることが重要であるが，長期にわたる経過観察中に典型的な所見を呈してきて診断がつくことも多い．

　There were six atypical cases (1.9％) which presented with findings of ulcerative colitis in 311 Crohn's disease (CD) cases at our hospital.

　The number of the cases of CD presenting with findings of UC was accepted to be, at the time of the first time inspection, four (67％), and the number of the cases which appeared during progress was two (33％), and they were seven years and nine years respectively after CD development of symptoms.

　The number of what was accepted as CD presenting with findings of UC in the rectum was three (50％).

　CD presenting with findings of UC progressed to CD classic cases was found in two cases (33％) and they were three years and eight years respectively after presenting with findings of UC appearance.

　Although it is important for diagnosis of CD presenting with findings of UC merger of CD to try to detect a non-caseating epithelioid cell granuloma, it is also important to observe over a long time the progress of an anal lesion or of a small intestinal lesion. A typical view is presented and the diagnosis sticks in many cases.