アフタ様潰瘍と微細病変から1年3か月の経過で典型的直腸炎型潰瘍性大腸炎の像を呈した1例

Distal Ulcerative Colitis with Only Aphthoid Ulcers and Minute Lesions in the Initial Clinical Stage, Report of a Case

要旨　患者は18歳，女性．血便を主訴として来院．全大腸内視鏡検査で盲腸および下行結腸にアフタ様潰瘍をはじめとする微細病変のみを認めた．Crohn病を疑い経過観察していたが，初回検査時より1年3か月後に典型的な直腸炎型潰瘍性大腸炎の像を呈するようになった．このような例の報告はなく，発症早期の微細病変とその経過を2年間にわたって観察しえたので報告した．

　An 18-year-old woman was admitted to our hospital with a complaint of blood on the surface of solid stool. Initial upper and lower GI endoscopic examinations revealed only aphthoid ulcers and the other minute lesions in the cecum and descending colon. At that time, these findings were thought to be compatible with Crohn's disease. The biopsy specimen from the rectum showed no abnormal findings.

　Fifteen months later, she noticed mucous bloody stool. Colonoscopic examination and barium enema showed diffuse, shallow and irregular ulcers in the rectum, suggesting typical ulcerative colitis, proctitis type.

　The lesions in the cecum, which were initially detected by magnifying endoscopic examination, had irregularly enlarged pits and pin-point aphthoid ulcers. These findings might be early lesions of ulcerative colitis. This is the first report describing early lesions preceding distal ulcerative colitis.