家族性大腸腺腫症に対する大腸切除術後に合併した小腸Crohn病の1手術例

Crohn's Disease Following the Subtotal Colectomy in a Patient with Familial Adenomatosis Coli, Report of a Case

要旨　22歳，男性．家族性大腸腺腫症の家系であったため，約3年7か月前に大腸亜全摘術を受けている．今回，突然の下血にて入院，吻合部潰瘍の診断で病変部回腸切除術を受けた．切除回腸に全層性炎症，亀裂を伴う潰瘍，非乾酪性類上皮細胞肉芽腫を認めた．また術後早期に再発し，内科的治療に反応したことや，そのX線・内視鏡所見から，Crohn病と確診した．本症例は家族性大腸腺腫症に合併したCrohn病としては第1例目と思われる．両疾患発症に直接の因果関係はないものと思われるが，本症例におけるCrohn病発症には，吻合部における何らかの障害が誘因となった可能性もあると考えられた．

　A 22-year-old man admitted to our hospital because of severe melena. He had undergone subtotal colectomy with ileoproctostomy for familial adenomatosis coli three years and seven months before. Barium enema showed stenosis at the anastomotic region as well as granular pattern of the mucosa with multiple irregularshaped ulcers. Resection of the stenotic region was performed because of continuing melena. Histological study of the resected ileum revealed transmural inflammation with aggregates of lymphocytes, many noncaseous epithelioid granulomas, ulcers with fissures and inflammatory polyps. About six months after the second operation, the similar lesions again noted in the anastomotic region. X-ray and endoscopic findings improved by nutritional treatment and medication. Based on these findings and clinical course, he was diagnosed as having Crohn's disease.

　This is probably the first case of Crohn's disease occurring after colectomy for familial adenomatosis coli. There may be, however, no direct relationship between the two diseases.