大腸Crohn病の非定型例の臨床―縦走潰瘍，敷石像を欠く症例の頻度と診断

Diagnosis of Crohn's Disease of the Large Intestine without Typical Features

要旨　初診時あるいは診断時に典型像（縦走潰瘍，敷石像）を欠いた大腸Crohn病（CD）（終末回腸または回腸末端部にも一部炎症が及んだ症例も含む）の臨床像，病変像を経時的に分析し，その診断の根拠と確実性について検討した．臨床症状よりCDを疑うが，肉芽腫を得なかった症例において大腸CDと診断するのに役立った事項は，①病変のskip，②縦列する小潰瘍群やアフタ，③同部や炎症性隆起部における炎症の程度が，粘膜層よりも粘膜下層において強いこと（sm＞m：disproportionate inflammation）であった．

　The clinical and pathological features of nine patients with Crohn's disease (CD) of the large intestine were analyzed. They didn't have typical features such as longitudinal ulcer and/or cobblestone appearance, at the time CD was diagnosed. CD of the large intestine is defined as CD without any abnormality on the x-ray examination of the small intestine. However, some of the cases revealed mild lesions of the terminal ileum observed by colonoscopic examination. Although a noncasing epithelioid granuloma was not present in the patients with CD of the large intestine, clinical and pathological findings such as 1) skip lesion, 2) linearly arranged aphthas or ulcers, 3) more prominent inflammation in the submucosa than in the mucosa (=disproportionate inflammation) were appropriate for the diagnosis of CD.