術後11年間経過観察を続けているCrohn病の1例

Crohn's Disease in the Course of Follow-up for 11 Years after Operation, Report of a Case

要旨　53歳，女性．1972年1月，右下腹部痛にて発症し，同年9月イレウス症状のため開腹．小腸潰瘍として約80cmの回腸切除を受けた．3年後に再発を認め，術後11年間保存的に経過観察を続けているCrohn病症例である．経過の要点は，①再発部位は腸切除吻合部より肛門側回腸であり，縦走潰瘍や敷石状外観所見のほかに浅い不整形潰瘍や輪状潰瘍も混在して認められた．②CRP値や白血球数などの変動が少なく，病勢把握にはX線や内視鏡による形態観察が必要であった．③1979年以後は自覚症状の消失は認められず，形態観察上も病変はほとんど寛解を認めない．④外来通院の状態では栄養状態の悪化や貧血が徐々に進行するため，ときに入院による強制栄養を必要とした．⑤病変部には狭窄性変化が認められ，その口側腸管の拡張が徐々に著明となっており，再手術の可能性も示唆されている．

　The patient, a 53 year-old woman, had an onset with right lower abdominal pain in January 1972 and underwent laparotomy for ileac symptom in September of the same year. She was diagnosed to have an ulcer of the small bowel and underwent a resection of 80 cm of the length of the ileum. However, the lesion recurred three years later so that she has been in the course of follow-up consecutively for 11 years since operation.

　The following points were recognized.

　(1) Lesions of recurrence existed in the ileum of the anal part of anastomosis for previous resection. Shallow irregularly-shaped and semicircular ulcers were seen here and there together with longitudinal ulcers or cobblestone appearance.

　(2) There was little change in the value of C-reactive protein or white blood cell count. Therefore it was indispensable to understand the condition of the disease by means of x-ray and endoscopy.

　(3) Since 1979, no disappearance of subjective symptom has been recognized and also the lesion showed no remission during morphological observation.

　(4) It was necessary some time to give her intravenous hyperalimentation by admission because in the outpatient clinic, malnutrition resulted and anemia progressed gradually.

　(5) Stenotic change was seen in the regions where the lesion was located and the dilatation of the bowel of the oral side of the stenotic lesion became clearer gradually showing the possibility of re-operation.