輪状潰瘍の合併を認めた小腸Crohn病の1例

Crohn's Disease with Circular Ulcer, Report of a Case

要旨　患者は36歳，男性で腹部疝痛で来院し，イレウスの診断で入院した．小腸X線検査で回腸に2か所の狭窄を認め，この狭窄の間にも輪状潰瘍の変形を認めた．狭窄は短く，対称性で，始めに腸結核も疑った．しかし，肛門側の狭窄には片側性の所見もあり術前診断はCrohn病であった．切除標本では肛門側の狭窄部には縦走潰瘍とcobblestone像が認められた．そして，その口側の拡張した腸管の部位には輪状潰瘍が認められた．そして，最も口側の狭窄部には地図状潰瘍が認められた．病理組織学的にはCrohn病と診断されたが輪状潰瘍，地図状潰瘍，拡張した腸管部の萎縮瘢痕帯の所見は新しいCrohn病の診断基準に当てはまらない所見であった．

　A 36-year-old man visited our hospital with the complaint of abdominal colic and was admitted under the diagnosis of ileus. X-ray examination of the small intestine revealed two stenotic lesions and a dilated lumen between them. At first, intestinal tuberculosis was suspected, because of the symmetrical appearance in the stenotic lesions. In a part of the anal stenotic lesion, irregular laterality was observed and the preoperation diagnosis was Crohn's disease.

　In the operated specimen, typical Crohn's macroscopic findings with longitudinal ulcer and cobblestone appearance were observed in the anal stenotic area and circular ulcers were present in the dilated area and serpigineus ulcer was found on the oral side.

　Those pathological findings were compatible with the Crohn's disease in the diagnosis.

　Circular ulcers in the dilated area and serpigineus ulcer were unusual findings in the diagnostic criteria of Crohn's disease.