潰瘍性大腸炎の臨床像が先行したCrohn病の1例

Crohn's Disease Presenting with Findings of Ulcerative Colitis Diagnosed by Long-term Follow-up Study, Report of a Case

要旨　患者は14歳の男性（1976年来院）で，主訴は1975年よりの下痢，粘血便．1976年の注腸X線検査で直腸から下行結腸まで連続性，びまん性の浅い潰瘍性病変を認め，潰瘍性大腸炎（以下UC）と診断された．発症3年5か月後の画像検査で，S状結腸，下行結腸にびまん性の潰瘍性病変の中に縦走潰瘍などの縦軸要素の所見を認めた．約8年間内科治療を行ったが，難治性であったため12年8か月後に大腸亜全摘出術が施行され，その摘出標本の上行結腸にはびまん性病変，S状結腸，下行結腸には多発する縦走潰瘍とその瘢痕像がみられた．15年5か月後に下痢が出現し，検査で小腸にCrohn病（以下CD）に典型的な縦走潰瘍を認めた．2年後，出血のために小腸部分切除が施行され，摘出標本の肉眼所見，病理組織所見は，縦走潰瘍や全層性炎症などCDに典型的な所見だった．本症例は経過中に病変の形態が変化し，発症時のUCから非典型的なCDと診断が変更された．

　A 14-year-old male was admitted to our hospital in 1976, with complaints of bloody stool and diarrhea. Barium enema and colonoscopy at the time of his first admissoin showed diffuse erosions and small ulcers from the rectum to the descending colon. The cecum to the transvers colon seemed to have suffered minimal change. At that time, these findings were suggestive of typical ulcerative colitis. During his clinical course, repeat barium enema and colonoscopy revealed longitudinal ulcers in the sigmoid colon and the descending colon, and eccentric deformity, angulation, and gradual distortion. His symptoms improved after administration of SASP and corticosteroids. However, bloody stool and diarrhea recurred many times and finally become refractory to medication. Subtotal colectomy was performed 14 years after the onset of symptoms. These findings and macro and micro findings of the resected specimen led to the final diagnosis of Crohn's disease and/or ulcerative colitis. Barium study in 1995 showed longitudinal ulcers in the ileum, and revealed Crohn's disease. A partial ileolectomy was performed 2 years after the barium study. Macroscopic and microscopic findings of the resected specimen were compatible with those of Crohn's disease. Long term follow-up is necessary to make an accurate diagnosis in such cases.