突然の下血を主訴とし，非定型的に発症したCrohn病の1例

Crohn's Disease with Unusual Onset, Report of a Case

　Crohn病は通常，腹痛，下痢，体重減少，発熱などを主症状として発症し，初診時には貧血，炎症所見，栄養障害などに関する検査所見の異常を高率に伴っている^1)～3)．最近，われわれは突然の下血を主訴とし，諸血液検査所見に全く異常を認めなかったCrohn病の非定型的発症例を経験したので報告する．

症　例

　患　者：37歳，男性，医師．

　主　訴：下血．

　既往歴：17歳時アレルギー性鼻炎．

　家族歴：特記すべき事項なし．

　現病歴：1976年夏過労時初めて腹痛（疝痛様）発作があったが，副交感神経遮断剤（ブスコパン）の注射ですぐ軽快した．以後，年に1～2回の頻度で過労あるいは暴飲暴食時などに同様の腹痛発作あったが，すぐ軽快していた．1983年4月12日夜，突然下腹部膨満感出現し，浣腸にて得た便は暗赤色を呈していたので，翌日精査のため当科外来受診．この間，下痢，体重減少，発熱は認められなかった．

　A 37-year-old man visited our hospital in April 1983 with sudden onset of melena. He did not have any typical symptoms of Crohn's disease such as abdominal pain, weight loss, fever. Physical examination disclosed no abnormalitie, at the abdomen, the anus and the peri-anal region. Upper gastrointestinal series disclosed no abnormalities. Barium enema showed no abnormalities in the colon but longitudinal ulcer and pseudodiverticular formation were noted in the ileum. The double contrast study of the small intestine disclosed longitudinal ulcer, eccentric rigidity and pseudodiverticular formation at three separated regions of the ileum, but their severity was mild and their lesions were limited in the narrow range. Initial laboratory data showed ESR, CRP, RBC and blood chemistry were all within normal limits. Furthermore, serum electrolytes, serum trace mineral (Zn, Mg, etc), serum vitamins were also within normal limits.

　Our case was unusual as Crohn's disease because melena was the only symptom and all blood tests showed no abnormalities.