アフタ様病変のみで発症し9年間経過が観察された大腸Crohn病の1例

Crohn's Disease: Progression from Aphthoid Colitis to Overt Crohn's Colitis, Report of a Case

要旨　患者は34歳，男性．下痢，体重減少で発症．3か月後の注腸X線検査，大腸内視鏡検査で大腸全域にわたり，密度に差はあるがアフタ様病変が認められ，生検で非乾酪性肉芽腫が証明された．更に，10か月後には縦走潰瘍へと進展し肛門部病変が出現した．2年4か月後に敷石像へと進展し，この時点で腸管を腫瘤として触知するようになった．TPNなどの栄養療法を主体に治療しているが，その後更に7年間の経過で，瘻孔形成などの重篤な合併症は出現しなかった．Crohn病に見られるaphthoid ulcerの進展様式とその意義について考察した．

　A 34-year-old man visited our hospital with the complaint of diarrhea and body weight loss. Barium enema and colonoscopic study revealed diffuse aphthoid ulcers scattered throughout the entire colon. Non-caseating granuloma was detected in the biopsy specimen taken from the aphthoid ulcers. Ten months later, the lesion progressed into longitudinal ulcers, and perianal lesion appeared. Two years and four months later, typical cobblestone appearance developed, and the thickened bowel was palpable as tumor. Since then, the patient has been treated for seven years mainly with nutritional therapy including total parenteral nutrition without any severe complication, such as fistula formation. We discussed the course and the significance of aphthoid ulcers in Crohn's disease.