アフタ様潰瘍から10年以上経過観察したCrohn病の3例

More Than 10 Year Follow-up Study of the Patients with Crohn's Disease with Aphthoid Ulcers from the Early Stage, Report of Three Cases

要旨　アフタ様潰瘍で発症し10年以上経過をみた3症例について注腸X線所見の推移を中心に報告した．〔症例1〕は16歳，男性．発熱を主訴に来院，初診時の注腸X線像では結腸全域にアフタ様潰瘍がみられた．このアフタ様潰瘍は1年5か月後の注腸X線像では消失していたが，2年後に再びアフタ様潰瘍で再発した。そして，3年5か月後には縦走潰瘍とcobblestone像のみられる進展例に移行した．5年後，15年後の注腸X線像では腸管は短縮し，狭細化・変形もみられ，また，粘膜は萎縮性となったが，依然として粘膜面にはアフタ様潰瘍の所見が認められた．〔症例2〕は52歳，女性．発熱，下痢で入院．初回の注腸X線像では全結腸に細かいアフタ様潰瘍を認めた．3か月後，このアフタ様潰瘍は消失したが，1年後の注腸X線像では再びアフタ様潰瘍が出現した．そして，2年1か月後には縦走潰瘍のみられる進展例となった．その後，栄養療法を確実に行ったところ自覚症状は消退し，10年8か月後，そして，15年後の注腸X線像でも潰瘍は瘢痕化し，粘膜面にもアフタ様潰瘍はみられず治癒像を示していた．〔症例3〕は51歳，女性．発熱，下痢で発症．初回の注腸X線像では結腸全域にアフタ様潰瘍が認められた．このアフタ様潰瘍は消長を繰り返し，10年後の注腸X線像でも萎縮性の粘膜面に認められた．また，初回の小腸X線像に認められたアフタ様潰瘍は4年6か月後の小腸X線像では短い縦走潰瘍に，9年後には典型的な縦走潰瘍とcobblestone像が認められるようになった．これらの症例の初回検査時にみられたアフタ様潰瘍は，いったん消失したが，その後また，アフタ様潰瘍として再発，次いで進展例に移行した．2例では長期経過後もアフタ様潰瘍は萎縮性の大腸粘膜に存在した．これらの観察から，アフタ様潰瘍はCrohn病の初期病変であると同時に基本的な所見であると考えられた．

　Three cases with Crohn's disease initially found with aphthoid ulcers by double contrast barium enema were reported with special attention to the change of the radiological findings in their clinical courses for more than 10 years.

〔Case 1〕 A 16-year-old man was referred to our clinic with complaints of fever and diarrhea. The initial double contrast barium enema revealed aphthoid ulcers scattered throughout the colon. Those aphthoid ulcers disappeared one year and five months later, but they came out again two years after the first barium enema. Three years and five months after the initial examination, he developed longitudinal ulcers and cobblestonelike lesions that were commonly seen in advanced Crohn's disease. The follow up barium enema examinations after five and 15 years showed small aphthoid ulcers on the atrophic mucosa in the shortened and strictured colon.

〔Case 2〕 A 52-year-old woman was presented to our clinic with high fever and diarrhea. The initial examination of double contrast barium enema showed small aphthoid ulcers scattered on the entire colon. Those aphthoid ulcers disappeared three months later, but they were found again by barium enema one year later. They were exacerbated and developed longitudinal ulcers and cobblestone appearance two years and one month after the initial examination.

　She had received a continuous and strict elemental diet therapy, barium enema examinations 10 years and eight months and 15 years after the initial examination showed a longitudinal ulcer scar with stricture only, but no aphthoid ulcers.

〔Case 3〕 A 51-year-old woman visited to our clinic with high fever and diarrhea. The initial double contrast barium enema demonstrated numerous aphthoid ulcers scattered throughout the colon. Those aphthoid ulcers had remittence and relapse for 10 years, and were still demonstrated by barium enema 10 years after the first visit.

　Aphthoid ulcers originally found in the middle of small intestine, disappeared once, but flared up and developed into short longitudinal ulcers, then typical longitudinal ulcers with cobblestone appearance in 10 years.

　Aphthoid ulcers in the first colon examination once disappeared, but recurred and developed into the typical radiological findings of Crohn's disease. They were still found on the atrophic mucosa of the colon after 10 years.

　These cases suggested that aphthoid ulcers would be an important finding of Crohn's disease as an initial as well as an essential sign.