非定型的潰瘍性大腸炎の診断と経過

Diagnosis and Natural Course of Atypical Forms of Ulcerative Colitis

要旨　炎症性腸疾患患者の大腸病変を遡及的に検討し，罹患範囲と併存病変から非定型的潰瘍性大腸炎と考えられる症例を抽出した．直腸と盲腸に限局した高度非連続性大腸炎（2例），一時点で肛門側の境界が明瞭であった区域性大腸炎（6例），連続性病変の口側に多発潰瘍を伴った潰瘍混在型大腸炎（3例），深部大腸ないし小腸Crohn病の経過中に出現したCrohn病合併大腸炎（2例），および円形ないし不整形潰瘍とアフタが多発する分類不能大腸炎（3例）が抽出された．高度非連続性大腸炎は大腸切除に至り，区域性大腸炎では1例が全大腸炎型に，2例がCrohn病に進展した．潰瘍混在型とCrohn病合併大腸炎は潰瘍性大腸炎に合致する罹患部位が難治性ないし再発性に経過した．一方，分類不能大腸炎は腸管外徴候を呈しながら慢性ないし再発性に経過し1例はCrohn病に進展した．以上のように，潰瘍性大腸炎の要素をもつindeterminate colitisの多様性が示唆された．

　We identified atypical forms of ulcerative colitis (UC) among our patients with inflammatory bowel disease. Unusual extent (skipped areas or segmental involvement) and major mucosal lesions in the proximal part of the involvement of UC were the criteria for atypical UC. Based on these criteria, there were two cases of severely inflamed skipped areas, six cases of segmental colitis, three cases complicated by colonic ulcers, two cases of UC occurring in Crohn's disease, and three cases of unclassified colitis. The severely inflamed skipped areas required colectomy. Among cases of segmental colitis and unclassified colitis, three cases subsequently developed Crohn's disease. It was shown that five of sixteen cases were actually cases of Crohn's disease. These observations suggest that indeterminate colitis of atypical form of UC are characterized by variable colorectal lesions with heterogeneous clinical courses.