肛門周囲膿瘍を伴う腸管アフタ様病変から3年後終末回腸に典型的な縦走潰瘍と狭窄像を呈したCrohn病の1例

Crohn's Disease Having Only Aphthoid Lesions at First and Showing Later Developed Longitudinal Ulcers, Report of a Case

要旨　患者は18歳，女性．肛門周囲痛，臍周囲痛，水様下痢，発熱を主訴に来院．肛門周囲膿瘍と血液検査上高度の炎症所見を認め，Crohn病を疑い消化管を検索したところ，胃前庭部に小びらん，終末回腸に小結節状隆起の多発集簇像，全大腸に散在性にアフタ様病変を認めた．大腸アフタ様病変からの生検組織に非乾酪性類上皮細胞性肉芽腫を認めたためCrohn病と診断し，salazosulfapyridine (SASP)投与で経過観察していたところ，3年後に終末回腸に典型的な縦走潰瘍が発生した．肛門部病変を伴う腸管のアフタ様病変で発症し，典型例へと進展したと考えられるCrohn病の1例を報告する．

　An 18-year-old woman was admitted to our hospital because of perianal pain, paraumbilical pain, watery diarrhea and fever. Perianal abscess was found and the laboratory examination showed severe inflammation. On gastrointestinal roentgenographies and endoscopic examinations, small erosive changes like aphtha were found in the prepyloric region of the stomach and scattered throghout the whole colon and rectum. Furthermore, small sessile polypoid lesions were seen in the terminal ileum. Histological examination of biopsy specimens obtained from colonic aphthoid lesions showed non-caseating epithelioid cell granulomas.

　Sulfasalazine treatment was prescribed, but three years later colonoscopic examination and radiographies revealed longitudinal ulcers and severe stricture in the terminal ileum.

　This is a case suggesting that aphthoid lesions are the earlier lesions of Crohn's disease.