十二指腸病変が発見の契機となったCrohn病の1例

Crohm's Disease Initially Suggested by Minute Duodenal Lesions, Report of a Case

要旨　患者は28歳の男性．21歳時から心窩部痛が出現し，24歳時から活動性十二指腸潰瘍およびびらん性胃炎と診断され投薬を受けていたが難治性であった．1991年3月から心窩部痛が再発．上部消化管内視鏡検査で十二指腸球部の活動性潰瘍，第2部の多発小潰瘍および幽門前庭部のびらん性胃炎を認め，前庭部の生検で非乾酪性類上皮細胞性肉芽腫が検出された．更に小腸の縦走潰瘍および小腸・大腸の多発性小潰瘍ないしアフタ様潰瘍を認めたためCrohn病と診断した．Crohn病における上部消化管の微細病変は本症の診断の契機となりうるので，その特徴を熟知しておく必要があると思われた．

　A 28-year-old man with a history of duodenal ulcer visited our hospital in March, 1991, complaining of epigastralgia. Upon upper endoscopy, an open ulcer and minute aphthous ulcers in the duodenum, and multiple erosions in the gastric antrum were detected. Because the biopsy specimens obtained from the antrumvrevealed epithelioid cell vgranuloma, the patient was suspected of having Crohn's disease. Double-contrast studies of the small intestine and the colon, and colonoscopy confirmed the findings characteristic of the disease. Our case suggests that careful observation during upper endoscopy can reveal findings which lead to a definite diagnosis of Crohn's disease.