Freep perforationを来した大腸クローン病の1例

Crohn's Disease Complicated with Free Perforation, Report of a Case

　慢性に経過するクローン病がfissuring ulcerを伴い，ときには腸管外に瘻孔を形成することはよく知られているが，腹腔内にfree perforationを来すことは比較的少ない．特に大腸クローン病では非常にまれとされている．

　われわれは炎症性大腸疾患として投薬治療開始1年2カ月後に，free perforationを来した大腸クローン病の1例を経験したので報告する．

　1. A report is made of a 53-year-old man with left-side Crohn's disease complicated with free perforation of the sigmoid colon.

　2. The patient was treated with Salazopyrin for about one year. In the meantime diarrhea became more frequent accompanied with bulbar subconjunctival bleeding, fever, and arthralgia. After the administration of predonisone (30 mg/day) all the symptoms were greatly alleviated. In the course of gradually decreasing administration of steroid (on the 76th day since the beginning of steroid therapy), perforation of the colon took place, so that the descending colon and the sigmoid were resected in addition to artificial anus colostomy. The rectum was left as it was.

　3. The resected specimen showed that eight longitudinal ulcers were arranged in three rows. Most of them were located along the teniae coli. The central part of the longest ulcer, located on the free side of the tenia coli of the sigmoid, was perforated about 6 cm long. Histologically, fissuring ulcer and granuloma were recognized.

　4. In the remnant rectum were seen densely distributed small protrusions with aphtoid ulcers on the tip of each of them. Such changes had been noticed even before the operation. Granulomas were demonstrated by exploratory resection of the mucosa.