大腸クローン病の2例

Crohn's Disease of the Colon

　大腸クローン病については，潰瘍性大腸炎との鑑別を中心に，Lockhart-Mummeryらの報告¹⁾²⁾以来，注目されてきているが，ここでは，自験2症例の臨床所見を紹介し，確診のための問題点および治療法について考察したい．

症例

　〔症例1〕

　橋○○子　22歳　女　事務員

　主　訴：粘血便

　既往歴：特記すべきことなし

　現病歴：1）約4年前より，貧血および大腸のレ線検査により左側結腸が細いことを指摘されていた．便通はやや下痢気味であったが，そのまま放置していた．その後，他医より痔瘻の診断の下，手術をうけ，約3カ月治療したが軽快せず，2年間に3度，瘻痩に対する手術を受けた．この頃になって粘血便の排出を認め，Tenesmusはないが，ときに1日10行前後の下痢をみた．直腸鏡検査により，潰瘍性大腸炎の診断をうけた．

　2）約1年前，瘻痩および肛門周囲膿瘍のため切開手術を受け，同時に潰瘍性大腸炎に対しステロイド剤などの内服をすすめられ，約6カ月間の治療で愁訴は軽快した．

　3）しかし，3カ月前より再び粘血便とともにTenesmusが出現，ステロイド剤を使用したが軽快せず，手術適応とされた．

　Two cases of Crohn's colitis were reported. The first case, a 22 years old female was suffered from perianai lesion for 4 years. By barium enema study, narrowing and longitudinal ulceration of the descending colon were demonstrated. Left hemecolectomy and colostomy at transverse colon was chosen because of her fecal incontinenz by perianai lesion. Resected specimen showed longitudinal ulceration and cobblestone appearance of residual mucosa.

　The second case is a 55 years old male. He complains lower abdominal discomfort and nausea. Segmental narrowing with ulceration of ileum was demonstrated by X-ray examination. By laparotomy skipping ulcerative lesion of entire colon were also shown. Total colectomy with ileoproctostomy was performed. After 2 years, fecal fistula appeared at his abdominal wall. It was a sign of recurrence of inflammatory bowel disease. Fecal fistula was communicating into the ileal lumen where the ileoproctostomy of the first operation was located at near 3 cm distance. Resection of the anastomotic portion and fecal fistula was performed. Histological examination of the specimen secured the recurrence of Crohn's ileocolitis.