長大な縦走潰瘍を有した小腸クローン病の1例

A Case Report of Crohn's Ileitis with Prominent Longitudinal Ulceration

　従来日本ではクローン病といえば急性クローン病のことを指し，欧米に多い慢性クローン病の報告は少なかった．しかし最近のCIOMS¹⁾の分類によれば，この急性型はクローン病とは別の疾患単位とされている．慢性型クローン病（以下クローン病と呼称）は既に本誌²⁾で特集が組まれ，第17回日本消化器内視鏡学会シンポジウム³⁾にもとりあげられたように，今日最も注目されている疾患の1っである．学会シンポジウムでは大腸クローン病に比し小腸クローン病の報告が少ないことが指摘されたが，このことは小腸X線検査に二重造影法がまだ十分とり入れられておらず，内視鏡検査も困難で，小腸疾患に対する関心がまだ高いとはいえないことも一因であろう．

　クローン病は今日なお概念や病態に不明の点が多い疾患である⁴⁾⁵⁾．このような状態においては疑わしい症例を詳細に検討することも大切であるが，一方においては臨床・病理両面から積極的にクローン病といえる症例を検討，集積することが必要であろう．今回長大な縦走潰瘍を有した小腸クローン病の1例を経験したので報告する．

　A case of Crohn's ileitis with a prominent longitudinal ulceration was reported.

　A 27 year-old-male. Since March '72, right lower quadrant discomfortness and tenesmus were noticed, and in June '73, appendectomy was received because of anorexia and r. l. q. pain. Since then, the symptoms were mild and intermittent until October '74, anorexia and abdominal pain appeared again and worsened. Then the patient admitted to our hospital for closer examinations and diagnosed as Crohn's ileitis. Operation was performed in March '75.

　A routine G-I tract roentgenography showed eccentric rigidity of the wall at mid-ileum. Roentgenography of small intestine with intubation double contrast method revealed skip lesions in the ileum. In the longest lesion, there were pseudodiverticula and a longitudinal ulceration of 20 cm in length. A barium enema study of the large intestine showed no remarkable change.

　At operation, between the point of 2 m from the Treitz band and the valve of Bauhin, 5 ulcerations were found. The longest ulcer was 70 cm in length and located just beneath the attachment of the mesentery. It was narrow in most parts, although in some parts widened and showed cobblestone appearance, Histological diagnosis was Crohn's disease.

　The case seems relatively simple or primitive and yet its longitudinal ulceration is prominent.