潰瘍性大腸炎との鑑別に難渋した長期経過Crohn病の1例

Follow-up Study of a Prolonged Case of Diffuse Type Crohn's Disease, Report of a Case

要旨　患者は27歳，男性（1983年来院）．1980年に1日5行の下痢，腹痛を生じ，その後粘血便（痔出血も伴う）を来した．注腸X線ではS状結腸と下行結腸のびらん性変化を，直腸鏡では直腸部のびらんと易出血性変化を指摘され，潰瘍性大腸炎（UC）と診断された．今回（1983年）は1日10行の下痢，腹痛，発熱を主訴とし精査目的で入院した．入院当初の大腸画像診断では直腸から上行結腸まで連続性にびらん，浮腫性変化，潰瘍性病変を認め，この段階ではCrohn病（CD）と確診される特徴的所見に乏しかった．その後の長期経過における画像では横行結腸，上行結腸に狭窄，縦走潰瘍を主病変とする病変が出現すると共に回腸末端部にもCDにcompatibleな病変が出現した．発症時のdiffuseな病変はUCにcompatibleであったが，約10年間の長期経過と共にCDに特徴的な画像が出現した．

　The patient was a 27-year-old man. In 1980, he complained 5 passages/day of diarrhea accompanied by abdominal pain and bloody mucous stool and bleeding hemorrhoids. Barium enema revealed erosive mucosal changes of the sigmoid and descending colons. Proctoscopic examination disclosed erosions and bleeding tendency in the rectum. Therefore, he was diagnosed with ulcerative colitis. In 1983, he was admitted with the chief complaints of severe diarrhea (10 passages/day), abdominal pain, and high fever. Radiologic examinations of early hospital days showed erosions, edematous changes, and ulcerations from the rectum to ascending colon. At that time, there were no definite signs indicating Crohn's disease (CD). However, diagnostic images obtained during the subsequent longterm follow-up period showed not only stenoses and longitudinal ulcers as main lesions in the transverse and ascending colons but also CD-compatible lesions in the terminal ileum. Although the diffuse changes observed at the initial phase of the disease were suggestive of UC, the follow-up study of 10 years duration provided data which were characteristic of CD.