⑥臨床経過よりクローン病が疑われた分類不能の腸潰瘍の1例

A Case of Unclassified Intestinal Ulcer: Suspected Crohn's disease from its clinical course

　近年，本邦においてもクローン病に対する関心が高まり，混乱を極めていたクローン病の疾患概念も次第に統一されてきた^1)～3)．クローン病との鑑別上，腸結核をはじめとする腸に潰瘍を形成する疾患の再検討も行われるようになった，腸に潰瘍を形成する疾患は必ずしも少なくなく，なかには疾患単位としてまだ確立されていないものすらみられるが，他の疾患と特徴像がoverlapする症例，またいかなる疾患とするにも決め手に欠ける症例の報告もみられる．

　われわれは，既知のいかなる疾患にも完全には合致せず，現時点では分類不能の腸潰瘍としか診断のつけようのない症例を経験したのでクローン病との異同を中心に報告する．

　A 29-year-old male, complaining of diarrhea and abdominal pain, was admitted to this hospital. He had underwent intestinal resection due to intestinal ulcer eight years before. X-ray examination demonstrated an irregularly-shaped ulcer with fistulous formation at the stoma (ileocecostomy) and several ulcers at adjacent region both proximal and distal to the stoma. A second operation for intestinal resection was performed. Six ulcers were recognized at the region and the ulcers were oval or irregularly-shaped. Neither longitudinal ulcer nor cobblestone appearance was recognized. Histologically, five of the six ulcers were Ul-Ⅳ and the other was Ul-Ⅲ. Transmural inflammation and fissuring were recognized. However, granuloma was not found in the intestine or in lymphnodes. An ulcer recurred at the proximal site of the stoma a year after the second operation. The ulcer was irregularly shaped and had clearcut margin and folds convergence. The number of recurring ulcer increased thereafter, namely four ulcers which were recognized two and a half years after the second operation. All of them were oval or irregularly-shaped.

　The clinical course and histologically confirmed transmural inflammation and fissuring resembled those of Crohn's disease. However, the shape of the ulcers were quite different.

　It would be appropriate to group this patient with unclassified intestinal ulcer for the meantime.