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Stomach and Intestine(Tokyo) Volume 25, Issue 6 （June 1990）

胃と腸 25巻6号（1990年6月発行）

Japanese English

今月の主題炎症性腸疾患の鑑別診断(2)―大腸病変を中心に

主題症例

アフタ様潰瘍の多発から典型的病像に進展したCrohn病の1例 A Follow-up Study of Crohn's Disease, Report of a Case: Roentgenologic and endoscopic appearance in the early stage; Evolution and retrogression of the ulceration 飯塚文瑛 ¹ , 長廻紘 ¹ , 山路千春 ¹ , 丸山明子 ¹ , 屋代庫人 ¹ , 佐藤秀一 ¹ , 大原昇 ¹ , 馬場理加 ¹ , 北畠滋郎 ² , 五十嵐達紀 ² , 秋本伸 ² , 吉本達雄 ³ Bun-ei Iizuka ¹ , Kou Nagasako ¹ , Kurato Yashiro ¹ , Shuichi Sato ¹ , Tatsuo Yoshimoto ³ ¹東京女子医科大学消化器病センター内科 ²東京女子医科大学消化器病センター外科 ³船橋病院内科 ¹Institute of Gastroenterology, Tokyo Women's Medical College ³Funabashi Hospital キーワード：アフタ様潰瘍 , Crohn病初期病変 , Crohn病病変の展開 Keyword: アフタ様潰瘍 , Crohn病初期病変 , Crohn病病変の展開 pp.697-705

発行日 1990年6月25日 Published Date 1990/6/25

DOI https://doi.org/10.11477/mf.1403110957

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要旨　患者は24歳，男性．初期病変から典型的病変への病像の進展の様子，病変部の治療への反応を，発症当初より2年間にわたり，X線・内視鏡で月に1回ずつ経過観察した，Crohn病(全大腸炎および回腸炎型)の症例である．初期X線診断は潰瘍性大腸炎で，初期寛解期の内視鏡像は直腸より回腸末端部までびまん性のアフタ様潰瘍の散在であった．発症後10か月目の再燃時に，結腸で縦に配列する小潰瘍群より短い縦走潰瘍へと病像が進展し，典型的生検像も得られてCrohn病と診断された．病期や部位によって異なる多彩な病像および潰瘍性病変の展開(進展・後退)について切除標本像も含めて検討して得た知見を述べる．

　A 24-year-old male with Crohn's colitis, diffuse type, was followed up by double contrast barium enema and colonoscopy, about once a month for two years. The course of evolution and retrogression of the ulceration, and polymorphous features according to the stage and distribution of the lesions are described in this report (Figs. 12 and 13). Involved areas were the total colon, rectum, and the terminal ileum. Anal lesions and other complications were not found. After medication with prednisolone and nutritional treatment in hospital for 2 years, resection of the total colon and the terminal ileum, and recto-ileostomy were done because of chronic inflammation.

　Numerous aphthoid ulcers were scattered on the normal mucosa throughout the entire colon and the terminal ileum. These were seen in the clinically remitting period at the early stage (Figs. 2 b, 3 a, b) and progressed to the typical lesions of Crohn's disease at ten months after the onset.

　Evolution of the ulceration occurred as follows; discrete ulcers were first arranged on a few longitudinal lines (Fig. 4), fusion of these ulcers then occurred resulting in the typical longitudinal ulcers in the same sites (Fig. 5).

　On the other hand, the lesion of these discrete ulcers retrogressed to the lesion of the scattered aphthoid ulcers twice in the clinically remitting period in six months after the onset.

　New aphthoid ulcers were found on the marginal mucosa of the longitudinal ulcers or ulcer scars (Fig. 10 c), which were elevated by underlying inflammation and edema in the submucosa, in the resected specimen (Fig. 11). They were arranged in a longitudinal direction, too.