炎症性腸疾患の直腸肛門部病変

Examination of Anorectal Lesions Accompanying Inflammatory Bowel Disease (IBD)

要旨　当施設で経験したIBDにおける直腸肛門部病変を検討した．Crohn病では83.8％に何らかの病変を合併した．痔瘻・膿瘍の頻度が最も高く(61.7％)，以下，skin tag(31.3％)，裂肛・潰瘍(24.2％)で，これらの病変は各々多発し，しかも種々の病変が混在(61.7％)することが特徴的であった．また，肛門部病変先行例81例(33.8％)のうち44例がCrohn病診断の契機となった．潰瘍性大腸炎にも17.0％に肛門部病変を合併したが，特徴的所見に乏しく，IBDにおける直腸肛門部病変を熟知することは両疾患の鑑別の上からも非常に有用と思われる．

　The anorectal lesion accompanying inflammatory bowel disease (IBD) was studied in our institution. Out of 240 patients with Crohn's disease, whose anorectal region was routinely examined, 201 (83.8％) presented with some sort of anorectal lesion. A perianal fistula/abscess was the most common with a frequency of 61.7％. Other main lesions included a skin tag in 74 patients (31.3％)and a fissure/ulcer in 58 (24.2％). The anorectal lesions of Crohn's disease were characterized by the mixed existence of these lesions in many locations. Eighty one patients (33.8％) initially presented with these anorectal lesions before abdominal symptoms were experienced and 44 (18.3％)had been diagnosed with Crohn's disease because of an anorectal lesion.

　For patients with ulcerative colitis, anorectal lesions presented with a frequency of 17.0％, and were similar to common lesions in appearance. It is considered that knowledge of the varied significance of the anorectal lesion is very helpful for the differential diagnosis of IBD, especially in cases of Crohn's disease.