竹の節状びらんが発見の契機となったCrohn病の1例―Crohn病に特徴的な胃体部小彎の微小病変の提唱

Crohn's Disease Showing "Bamboo Joint-like Erosions" of the Gastric Bodyand Cardia, Report of a Case: A Novel Sign as a Clue of Having Crohn's Disease

要旨　患者は32歳，男性．心窩部から臍周囲部痛のため近医を受診した．胃内視鏡検査で十二指腸球部の顆粒状病変と噴門部から胃体中部小彎にかけて念珠状に連なる3条の隆起性変化を認めた．敷石状外観様であるが，縦走潰瘍はなく，皺襞を比較的規則正しく横切る浅いびらんが縦に配列することにより形成された病変であった．このびらん部分からの生検で肉芽腫が検出されCrohn病が疑われた．小腸造影で縦走潰瘍，敷石像が確認され，小腸型Crohn病と診断された．以後Crohn病患者の胃体部小彎を注目して観察したところ，計25例中13例52％に類似した所見が認められ，その特異な外観から"竹の節状びらん"と命名した．文献的記載がなく，Crohn病を示唆する特徴的な胃体部小彎病変として提唱する．

　A 32-year-old man, complaining of epigastralgia and peri-navel pain, took an endoscopic examination in August, 1989. A curious lesion was observed on the lesser curvature from the cardia to the middle gastric body. This lesion consisted of three enlarged folds transversed by fissuring erosions in a longitudinal alignment, but lacking a longitudinal ulcer. Biopsy from a fissuring erosion disclosed microgranulomas indicating Crohn's disease. Definite diagnosis of Crohn's disease ileitis type was obtained with x-ray examination of the small intestine, showing longitudinal ulcers, cobblestone appearance and intestinal strictures as skip lesions. Since then, we have paid attention to the lesser curvature of the gastric body and cardia in the endoscopic observation of Crohn's disease patients. Similar lesions were found in 13 patients (52%) out of 25 cases of Crohn's disease. Although enlargement of folds was less prominent, these lesions showed the same location, morphology and histopathology in biopsy as the lesion of the case presented. We named this endoscopic sign "bamboo joint-like erosions".Microgranulomas were detected in 8 cases (64%) out of 13 patients with bamboo joint-like erosions, by examining 50 serial sections of biopsy specimens. We propose the bamboo joint-like erosions of the gastric body as a novel endoscopic sign of Crohn's disease.