Diagnosis of Disease Involving the Large Bowel N. Hiwatashi 1 , H. Watanabe 1 , Y. Goto 1 13rd Dept. of Internal Medicine, Tohoku University School of Medicine pp.461-472
Published Date 1978/4/25
DOI https://doi.org/10.11477/mf.1403107269
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 Twelve cases of Crohn's disease involving the large bowel (5 involved both small and large bowel and 7 only large bowel) are studied with special reference to the characteristics on clinical signs, laboratory data, X-ray findings, endoscopic findings and histologic findings of biopsy material.

 Following conclusions were obtained in the comparative study with intestinal tuberculosis.

 1. Abdominal pain, diarrhea, loss of body weight, fever and abdominal tumor were common in both diseases, but bloody stools, external fistula and anal lesion were characteristic of Crohn's disease.

 2. The tuberculin test was negative in most cases of Crohn's disease, but positive in almost all cases of intestinal tuberculosis. The demonstration of tubercle bacilli from feces and biopsy tissues of lesions was difficult in the latter.

 3. In X-ray findings and endoscopic findings discontinuous or segmental lesion associated with stenosis was seen in both diseases. The cobblestone appearance, gyrous lesions. longitudinal ulcers in the small bowel, fissures and fistulae were chracteristic of Crohn's disease. On the other hand, scarred area, pseudopolyposis, irregular undermined ulcers, circular ulcers were characteristic features of tuberculous lesion.

 4. Granulomas were frequently observed in biopsy material of both diseases. However, recognition of caseous necrosis was almost impossible even in tuberculous lesion. Granulomas of the mucosa even in tuberculosis were solitary and small and very difficult to differentiate from those in Crohn's disease. On the other hand, “disproportional inflammation”, normal mucosa intervening in the lesions and neuromatous hyperplasia in the submucosa were frequently observed in Crohn's disease.

 5. If the above mentioned differential points are applied, the clinical differential diagnosis in typical cases appears to be definitely possible.

 Since the demonstration of tubercle bacilli or caseous necrosis in the tissue is difficult, therapeutic differential diagnosis with antituberculous therapy should be used in atypical cases.

Copyright © 1978, Igaku-Shoin Ltd. All rights reserved.


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