虫垂Crohn病の1例と本邦報告例の検討

Crohn's Disease of the Appendix, Report of a Case, as well as a Review of Previously Reported Cases in Japan

要旨　患者は43歳，男性．突然の右下腹部痛を主訴に来院．筋性防御を伴う圧痛を認めることから急性虫垂炎穿孔による腹膜炎を疑い，緊急手術を施行した．手術所見では，虫垂周囲に大網の癒着を伴い，これを剥離すると著明に腫大した虫垂があり，ほぼ中央部に穿孔を認めた．切除された虫垂は全長5.5cm，直径3.5cmと棍棒状に腫大していた．病理組織学的には，虫垂壁は好中球とリンパ球の全層浸潤と線維化を伴う全層性炎症のため著明に肥厚し，非乾酪性肉芽腫を認めた．更に，虫垂切除後に小腸，大腸の検索を行ったが，異常所見は認めなかった．以上の所見から虫垂Crohn病と診断した．虫垂切除2か月目に回腸盲腸瘻を形成したため回盲部切除を施行した．患者は術後9年目に脳出血で死亡したが，この間Crohn病の再発の徴候は認めていない．

　A case of Crohn's disease confined to the appendix is presented. The patient, a 43-year-old man, was admitted to the hospital with complaint of pain in the right lower quadrant. Physical examination at that time had revealed guarding and rebound tenderness of the right lower quadrant of the abdomen, but the preoperative impression was that there was a perforation of the appendicitis with peritonitis. A laparatomy was performed and the appendix was found to be inflamed, markedly enlarged and perforated. The appendix measured 5.5 cm in length and 3.5 cm in diameter at its greatest diameter. Histologically, the wall was greatly thickened by inflammatory infiltration and fibrous tissue. The infilrate was composed of lymphocytes, neutrophils, and the presence of epithelioid granulomas. As a result of histological findings, we diagnosed this as a case of Crohn's disease of the appendix. Fistulization occurred two months after appendectomy, and a limited ileocolectomy was performed. Since surgery he had been free of Crohn's disease for the nine year period of follow up until he died from cerebral bleeding.