盲腸周囲炎を合併した回盲部限局性Crohn病の1例

Crohn's Disease Presenting a Regional Stenosis of the Terminal Ileum and Perityphlitis, Report of a Case

要旨●患者は30歳代，女性．201X年2月下旬より右下腹部に違和感を自覚した．その後右下腹部痛，嘔気嘔吐，下痢も伴うようになり，発症から約3週後に当科を受診した．右下腹部に手拳大の有痛性腫瘤を触知し，造影CT検査では回盲部から上行結腸にかけて壁肥厚と周囲の脂肪織混濁所見を認めた．大腸内視鏡検査，注腸および小腸X線造影検査では回腸終末から回盲弁にかけて限局性の高度狭小化，盲腸から上行結腸に腸間膜付着側優位の壁伸展不良を認めた．通過障害のため腹腔鏡補助下回盲部切除術が施行された．病理組織学的所見では回腸終末腸間膜付着側に縦走潰瘍および裂溝，壁外膿瘍がみられ，盲腸部は膿瘍の波及による漿膜炎が主たる所見であった．虫垂を主として回腸壁にも非乾酪性肉芽腫を認め回盲部限局性のCrohn病と診断した．消化管の他部位に病変は指摘されず，2年経過した現在も無症状，無所見で経過観察中である．

　A 32-year-old woman was referred to our hospital because of pain in the right lower abdominal region. She was apparently well until approximately 3 weeks before the referral, when episodes of pain in right lower quadrant, diarrhea, and nausea developed.

　Physical examination revealed a painful, fist-sized mass in the right lower quadrant, and computed tomography of the abdomen showed thickened ileocecal wall and surrounding fat tissue. Colonoscopy, barium enema, and small bowel X-ray examination showed segmental narrowing of the terminal ileum and perityphlitis with a longitudinal stricture of the mesenteric side of the cecum through the distal ascending colon. Laparoscopy-assisted ileocecal resection was performed due to severe stenosis of the terminal ileum. Histopathological findings revealed a longitudinal transmural ulcer with profound fissure and abscess on the mesenteric side of the terminal ileum. The cecum was mainly affected with serositis caused by ileal ulcer and abscess. A few non-caseous epithelioid granulomas were seen in the ileum wall; furthermore, many granulomas were seen in the appendix. Accordingly, the patient was diagnosed with Crohn's disease. She has been under careful observation without any medication and remains asymptomatic 2 year after ileocecal resection.