十二指腸狭窄で発見されたCrohn病の1例

Crohn's Disease of the Duodenum, Report of a Case

要旨　患者は21歳，女性．十二指腸潰瘍として内科的治療が施行されていたが，治療に抵抗し，手術目的にて当科入院となった．入院後の精査で，十二指腸の狭窄のほかに，小腸，大腸にも病変を認め，Crohn病と診断した．salazosulfapyridineの投与および中心静脈栄養にて，自他覚的に症状の改善がみられ，外来通院での管理が可能となった．胃・十二指腸Crohn病はまれであり，本邦では自験例を含め13例の報告があるが，内科的治療にて寛解したのは4例のみである．本症の内科的治療の長期的予後は明らかでなく，今後も慎重な経過観察が必要である．

　A 21-year-old female, who had been treated as duodenal ulcer, was admitted to our hospital with the complaints of nausea and vomiting. Radiological and endoscopic examinations revealed stenosis and granular lesions in the duodenal bulb. Barium enema examination showed longitudinal ulcer and cobblestone-like appearance of the sigmoid colon and the terminal ileum. Biopsy specimen obtained from the duodenum revealed non-caseating granuloma. These findings led to the diagnosis of Crohn's disease of the duodenum. Duodenal stenosis was improved by conservative treatment with salazosulfapyridine and NPO with intravenous hyper-alimentation.