大腸敷石像―他疾患の炎症性ポリポーシスとの鑑別を含めて

Radiographic and Endoscopic Features of Cobblestone Appearance in Crohn's Colitis: Comparison with Inflammatory Polyposis in Ulcerative Colitis and Intestinal Tuberculosis

要旨　Crohn病でみられる敷石像のX線・内視鏡所見の特徴を，他疾患との鑑別を含め検討した．対象は，大腸に潰瘍性病変（縦走潰瘍，不整形小潰瘍）とそれに随伴した敷石像・炎症性ポリープを有するCrohn病41例に加え，潰瘍性大腸炎33例と腸結核8例である．①敷石像のX線学的所見として，密集する小隆起と開放性潰瘍（裂溝，縦走潰瘍，小潰瘍）の存在が重要であった，②敷石像類似の密集性小隆起は一部の潰瘍性大腸炎でもみられたが，縦走性変化はなく，縦走性変化を有する敷石像はCrohn病の診断に特異度の高い所見と考えられた．③敷石像は入院治療により改善し，多くは縦走潰瘍に炎症性ポリープが随伴するタイプに変化したが，潰瘍が消失しても密集性小隆起が残るタイプは長期経過中に狭窄が進行する例が多かった．以上から，敷石像はCrohn病の診断と予後推定に重要な所見と考えられた．

　To assess cobblestone appearance in Crohn's disease, we investigated the radiographic and endoscopic features of the colon presenting as ulcers and inflammatory polyposis in 41 patients with Crohn's colitis in comparison with those in 33 cases of ulcerative colitis and 8 cases of intestinal tuberculosis. The radiographic features of cobblestone appearance were considered as dense inflammatory polyposis with concomitant open ulcers such as fissuring, longitudinal and serpiginous ulcers. Inflammatory polyposis mimicking cobblestone appearance was also seen in ulcerative colitis, although it lacked longitudinal changes. Cobblestone appearance with longitudinal changes seems to be the diagnostic criterion for Crohn's disease. Cobblestone appearance frequently recovered to sparse inflammatory polyposis with longitudinal ulcers. Dense polyposis without open ulcers was likely to progress to colonic stenosis for a long period. It is considered that cobblestone appearance is important for diagnosis and prognosis of Crohn's disease.