大腸を主とし口腔・胃・十二指腸および肝にも病変を合併したクローン病の1例

Crohn's Disease Affecting the Soft Palate, Stomach, Duodenum and Liver in Addition to the Colon, Report of a Case

　上部消化管のクローン病は，本邦ではなお極めてまれな疾患である．われわれは，大腸クローン病（疑診例）の経過中に十二指腸球部狭窄を生じ手術の結果，胃・十二指腸病変を伴うクローン病と確診できた症例を経験したので，文献的考察を加えて報告する．

　A 16-year-old boy, who has been treated for colonic Crohn's disease since January 1979, complained of a sore throat in February 1980. Examination showed many vesiculations with surrounding redness on the soft palate, and an ulceration at the base of the uvula. These lesions subsided within six weeks. In April 1981, he was hospitalized because of postprandial vomiting. Upper gastrointestinal examinations revealed a marked stenosis and a cluster of polypoid lesions in the duodenal bulb. The prepylorus and the upper part of the duodenal second portion were also involved to some extent. Conservative treatments for one month were followed by a partial gastrectomy in May 1981. Macroscopically, the resected specimen showed a marked thickening of the prepyloric and bulbar wall, and a cobblestone appearance and two ulcers were observed in the duodenal bulb. Histopathological examinations showed many fissuring ulcers and non-caseating granulomas in the gastroduodenal wall. An undermining ulcer in the anterior wall of the duodenal bulb communicated with the fissuring ulcers in the prepylorus through a submucosal tunnel-like sinus. A simultaneous liver biopsy showed the sinusoidal dilatation and the lymphocytes infiltration in the portal areas.