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Stomach and Intestine(Tokyo) Volume 41, Issue 6 （May 2006）

胃と腸 41巻6号（2006年5月発行）

Japanese English

今月の主題非定型的炎症性腸疾患―診断と経過

主題

非定型的Crohn病の診断と経過―内視鏡所見を中心に Diagnosis and Clinical Course of Atypical Cases with Crohn's Disease from the Standpoint of Endoscopic Findings 岩男泰 ^1,2 , 杉野吉則 ³ , 井上詠 ^1,2 , 高石官均 ^1,2 , 桜庭篤 ¹ , 矢島知治 ¹ , 久松理一 ¹ , 岡本晋 ¹ , 今枝博之 ¹ , 緒方晴彦 ¹ , 日比紀文 ¹ , 向井萬起男 ⁴ Yasushi Iwao ^1,2 , Yoshinori Sugino ³ , Nagamu Inoue ^1,2 , Hiromasa Takaishi ^1,2 , Astushi Sakuraba ¹ , Tomoharu Yajima ¹ , Tadakazu Hisamastu ¹ , Susumu Okamoto ¹ , Hiroyuki Imaeda ¹ , Haruhiko Ogata ¹ , Toshifumi Hibi ¹ , Makio Mukai ⁴ ¹慶應義塾大学医学部消化器内科 ²慶應義塾大学包括先進医療センター ³慶應義塾大学放射線診断科 ⁴慶應義塾大学病理診断部 ¹Division of Gastroenterology, Department of Internal Medicine, Keio University School of Medicine ²Center for Comprehensive and Advanced Medicine, Keio University School of Medicine ³Department of Diagnostic Radiology, Keio University School of Medicine ⁴Department of Pathology, Keio University School of Medicine キーワード： Crohn病 , 潰瘍性大腸炎 , indeterminate colitis , アフタ , 非乾酪性肉芽腫 Keyword: Crohn病 , 潰瘍性大腸炎 , indeterminate colitis , アフタ , 非乾酪性肉芽腫 pp.925-938

発行日 2006年5月25日 Published Date 2006/5/25

DOI https://doi.org/10.11477/mf.1403100613

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要旨　典型的所見を呈さない非定型的Crohn病（CD）として，初期病変のみから成るCD 12例および潰瘍性大腸炎（UC）として経過観察中にCDと診断された6例を検討した．アフタのみから成る非定型CDのうち3例で小腸，3例で大腸病変が典型病変に進展した．進展例，非進展例で臨床背景，治療内容に差はなかった．進展例においても手術例はなく長期予後は良好であった．びまん性病変を呈し潰瘍性大腸炎と診断されていた非定型CD例のうち，全大腸型右側優位とされていた3例はいずれも肉芽腫検出により診断された．左側大腸炎型の症例は見直し診断によってもUCとしか診断しえなかった．うち1例は難治性型として手術後の標本に肉芽腫が確認された症例であり，他の2例はUC類似の所見消失後に典型病変が出現した症例であった．びまん性病変などすべての病像をCDで説明しうるのか，UCとCDの合併例として扱うかなど，今後さらに症例を集積して分析，検討すべきと考えられた．

　Clinical course and endoscopic findings were analyzed in 18 atypical cases with Crohn's disease (CD), 12 cases of aphthous type, 6 cases of diffuse colitis type. In 3 cases of apthous type, the lesions of the large intestine progressed to typical lesions (longitudinal ulcer), and in another 3 cases, the lesions of the small intestine progressed to typical cases. There were no significant differences between the progressive cases and non-progressive ones in their clinical aspects. No patient underwent surgical treatement. Among 6 cases of diffuse colitis type, three cases presented total colitis predominantly on the right-side and three cases presented left-sided colitis. The endoscopic findings of these cases showed continuous coarse mucosa similar to the typical findings in Ulcerative colitis (UC), but it was impossible for us to make a differential diagnosis between typical UC by re-evaluation of endoscopic and the pathologic findings. In 3 cases of right-side-dominant colitis, non-caseating epitheloid cell granulomas were detected from the large intestine (2 cases) and the upper GI tract (1 case), and we diagnosed these cases as CD. On the other hand, one case of left-sided colitis recerved total colectomy due to its intractablity. Many epitheloid granulomas were detected in the operated specimen and we diagnosed this case as CD. In the other 2 cases of left-side diffuse colitis type, UC-like lesions had disappeared and typical lesions (longitudinal ulcers) had appeared. More analysis is necessary because the clinical features and course of aypical CD are not uniform.