大腸Crohn病の臨床―縦走潰瘍，敷石像を欠く症例の診断―X線診断を中心に

Clinical Study of Crohn's Disease in the Large Intestine: Radiological Diagnosis of Cases without Longitudinal Ulcer nor Cobblestone Appearance

要旨　経過観察しえたCrohn病（以下CD）の大腸にみられる画像所見を整理し，縦走潰瘍や敷石像を欠いた症例のX線診断について検討した．当施設で診断されたCD129例中で画像を十分に検討しうる症例50例（小腸型10例，小腸大腸型30例，大腸型10例）を対象とした．非定型例は全例小腸大腸型で10例だった．画像所見を部位ごとに検討すると上行結腸には，敷石像が多く，肝彎曲，横行結腸，下行結腸には縦走潰瘍が，S状結腸には不整形潰瘍が多かった．アフタ様病変，点状のバリウム陰影（以下BaF），小透亮像（以下FG）はS状結腸を中心とした左半結腸に多かった．敷石像を認める部位は経過中80％が手術された．縦走潰瘍は瘢痕化するもの，再燃・緩解を繰り返すものそれぞれ40％だった．縦走潰瘍，敷石像を認める以前にみられた画像はアフタ様病変のほか，BaF，FGもあり，11例は異常所見のない部位からも生じていた．非定型例では定型例に比べ，全部位でアフタ様病変，BaF，FGが多く，特に下行結腸で出現率が高かった．非定型例10例の中で5例に経過中縦走潰瘍や敷石像を生じた．縦走潰瘍や敷石像のみられた部位には縦軸要素（longitudinal involvement）を示唆する変形が長期間残ることが多く，非定型例の診断にはそれらの変形を参考にして縦軸要素を診断することが重要と考えられた．

　Clinical course and radiological findings were analyzed in fifty cases with Crohn's disease (10 cases of small intestinal type, 30 cases of small intestine-large intestinal type, 10 cases of large intestinal type). Ten cases had atypical radiological findings: there was no longitudinal ulcer nor cobblestone appearance, and all of them were classified into small intestinal type. In the ascending colon, cobblestone appearance was frequently noted. At the hepatic flexure and in the trasverse and descending colons, longitudinal ulcers were commonly found. In the sigmoid colon, serpiginous ulcers were most common finding. Aphthoid ulcers, barium flecks, fine granular defects were noted mainly in the left-hemi colon. Eighty percent of the lesions with cobblestone appearance was resected during their clinical course. Forty percent of the patients with longitudinal ulcers healed to scar and 40 percent of them repeated remissions and relapses. The legion with longitudinal ulcer and/or cobblestone appearance succeeded aphthoid ulcers, barium flecks, fine granular defects and/or normal mucosa. Atypical cases were more likely to have aphthoid ulcers, barium flecks, fine granular defects than typical cases. Many lesions with longitudinal ulcer and/or cobblestone appearance resulted in deformities suggesting longitudinal involvement in a long time. Therefore, for the diagnosis of atypical Crohn's disease, it is important to detect longitudinal involvement in various deformities.