小腸造影検査が有用であった小腸型Crohn病の1例

Small Intestinal Type of Crohn's Disease for Which Radiography of the Small Intestine was Useful, Report of a Case

要旨　症例は14歳，女性．10歳ごろから腹痛等の症状が出現していたが看過され，標準から－2SDを示す成長障害を伴い当科紹介された．上部消化管内視鏡検査にて胃にたこいぼびらん，竹の節上外観，十二指腸にアフタ様病変，Kerckring皺襞にnotch様外観などCrohn病の副所見を認め，また食道にも縦列傾向を示した微小なアフタ様病変を認めたが，これらからの生検では非乾酪性類上皮肉芽腫を断定できなかった．しかし小腸造影検査を施行したところ下部空腸から回腸にかけて著明な腸管の直線化，狭小化を認め，また偽憩室化した部分も認められ，縦走潰瘍やcobblestone appearance等のCrohn病の典型像が明瞭に描出された．以上から上部消化管病変を伴った小腸型Crohn病と診断した．Crohn病の診断，画像所見について若干の文献的考察を加えて報告した．

　A 14-year-old girl was admitted to our hospital with long-term abdominal pain and growth disturbance. She felt abdominal pain occasionally, but neighborhood pediatrics diagnosed her state as acute gastroenteritis or psychogenic disease. Upper gastrointestinal endoscopic examination was performed, and we recognized bamboo joint-like appearance in the upper gastric body, aphthoid erosion, the so-called “Taco-Ibo” erosion, in the pre-pyloric area, several aphtoid ulcers in bulbous portions, many small-depressed erosions on Kerckring folds, and “notch-like appearance” in the second portion of the duodenum. We also noticed many small and longitudinal aphthoid lesions in the esophagus. We took biopsy-specimens from these lesions, but we couldn't discern granuloma in them. Next, small intestinal radiographic examination was performed. We recognized many radiographic features peculiar to Crohn's disease ; longitudinal ulcerations, cobblestone appearance, and pseudo-diverticulum formation. Finally we diagnosed this case as a small intestinal-type of Crohn's disease.