非定型的潰瘍性大腸炎との鑑別が困難であった大腸Crohn病の1例

A Case of Crohn's Colitis Which Was Difficult to Differentiate from Ulcerative Colitis

要旨　患者は22歳の男性で，主訴は粘血便と発熱である．初回発症時の注腸・内視鏡所見では，S状～横行結腸にかけて連続性・びまん性にhaustraは消失し，粘膜面は粗ぞうでびらんおよび小潰瘍が散在していた．直腸は肉眼的にほぼ正常であった，この時点で非定型的な潰瘍性大腸炎(萎縮性大腸炎型)と診断され，サラゾピリン，ステロイド投与が行われた．その後3回にわたり再燃を繰り返し，次第に内科的治療に反応しなくなったので初発より約3年後に手術が施行された．本症例は経過をみるうちに縦走潰瘍，腸管の非対称性変形や狭小化が顕著となり，手術標本肉眼・組織所見でも大腸Crohn病に合致する像を呈した．初発から全経過を通じて本例の直腸はほぼ正常のままであった．

　A 22-year-old male was admitted to our hospital with complaints of bloody stool and fever. Barium enema and colonoscopy at the first admission showed the disappearance of haustration, diffuse and fine mucosal granularity, erosions and small ulcers from the sigmoid colon to the transverse colon. The rectum seemed to be grossly normal. At that time, these findings were most suggestive of atypical ulcerative colitis (atrophic colitis type).

　His symptoms improved after the administration of SASP and corticosteroids. However, bloody stool and fever recurred three times and finally became refractory to the medications. Subtotal colectomy was then performed three years after the onset of symptoms.

　During his clinical course, repeat barium enema and colonoscopy revealed that longitudinal ulcers, eccentric deformity and narrowing developed gradually. These findings and macro- and microscopic findings of the resected specimen led to the final diagnosis of Crohn's colitis. The rectum was not involved throughout the course in this case.