Spontaneo usumbilical fistulaを形成した小腸Crohn病の1例

Crohn's Disease with Spontaneous Umbilical Fistula, Report of a Case

要旨　患者は18歳男性．臍分泌，腹痛を主訴として当院を受診した．痔瘻痕手術の既往はあるが開腹術の既往はない．小腸造影，瘻孔造影にて回腸臍瘻を形成した小腸Crohn病と診断された．1985年8月，臍回腸瘻を含めた約95cmの回腸を一括して摘出した．摘出標本には縦走潰瘍，跛行性潰瘍およびアフタ様潰瘍のskip lesionを認めた．組織学的には全層に及ぶ潰瘍，epithelioid granulomaをみた．瘻管壁には非特異的炎症性変化しかみられなかった．以上より自然臍回腸瘻を伴った小腸型Crohn病と診断した．本邦にこのような症例の報告はなく，文献上の6報告例を加えて考察した．

　An 18 year-old man was referred to our hospital with complaints of umbilical discharge and abdominal pain. He had no history of laparotomy. Preoperative small bowel roentogenography revealed Crohn's disease of the ileum with umbilical fistula. In August 1985, en bloc excision of the fistula and diseased ileum was performed. Surgical specimen showed longitudinal ulcer, serpiginous ulcer and skip lesion of aphthoid ulcer. Microscopic findings showed transmural ulcer and epithelioid granuloma. The well of the fistula showed only non-specific inflammatory change. We diagnosed this case as Crohn's disease with spontaneous fistula. Previously reported six cases of Crohn's disease with spontaneous umbilical fistula were discussed.