長期経過観察中のCrohn病の1例―術後再発の進展様式について

Long Followed-up Crohn's Disease with Special Reference on Radiographic and Endoscopic Course of Recurrence, Report of a Case

要旨　患者は14歳女性．1974年2月腹痛出現．肛門周囲膿瘍もみられ1975年7月本院受診．注腸造影，大腸鏡にてCrohn病と診断し1976年3月22日手術を施行．病理学的にもCrohn病と診断．1976年12月吻合部の再発が指摘され，1978年7月2回目の手術を施行．再手術後の経過観察では，1979年8月注腸造影にて吻合部口側20cmにわたり顆粒状粘膜，アフタ様潰瘍，偏在性壁硬化を，大腸鏡ではアフタ様潰瘍が散見された．同年9月アフタ様潰瘍の拡大と増悪がみられ，同年12月不整～縦走潰瘍や仮性ポリープを伴う敷石状外観となった．1981年3月吻合部を中心に縦走潰瘍，敷石状外観の進展，管腔狭小化を認めた．metronidazole投与2カ月後の1981年6月，吻合部近傍の潰瘍の多くは瘢痕化し狭窄と仮性ポリープを残すのみとなった．本例の特徴は術後の変化を経時的に詳しく追跡しえたことであり，アフタ様潰瘍から敷石状外観への変化が確認された．

　A 14 year-old girl was admitted to Kitasato University Hospital with abdominal pain and perianal abscess on July 22, 1975. Barium enema studies revealed cobblestone appearances in the ascending colon and skipped lesions in the distal ileum. Operation was performed on March 22, 1976 because of its exacerbation, and its histological diagnosis was proved as Crohn's disease. In December 1976 recurrence at the anastomotic area was pointed out, and the second operation was undergone on July 7, 1978. Macroscopically, the resected specimen exhibited an internal fistula and cobblestone appearances. On follow-up studies after the second operation, we could reveal the process of recurrence radiographically and endoscopically. In August 1979, granular mucosa and aphthoid ulcers were shown from the proximal ileum to the anastomotic area on x-ray films, and several small irregular and aphthoid ulcers on colonoscopy.

　In September 1979, these ulcers increased in size and number. In December 1979, they progressed to cobblestone appearances with large serpiginous or longitudinal ulcers and pseudopolyps. In March 1981, cobblestone appearances were extended from the anastomotic stricture to the distal colon. In June 1981, two months after medication of Metronidazole, most of these ulcers were healed to scars leaving only stenosis and pseudopolyps. And on follow-up study, we couldn't find active ulcers.

　The characteristic of this case-report is a close follow-up observation of recurrence after surgery.