無治療で寛解期が1年持続している大腸Crohn病の長期観察例

Crohn's Disease of the Colon Followed-up for Five Years, Report of a Case

要旨　5年間の経過観察中，臨床的に1度も増悪をみず，少なくとも最近1年間は寛解状態にあると考えられる大腸Crohn病の1例を経験したので報告した．症例は28歳，男性．粘液便と上腹部痛を主訴として来院した．初診時，上腹部に腫瘤を触れ，肛門部に痔瘻を認めた．注腸X線および内視鏡検査で横行結腸に縦走潰瘍とcobblestone appearance，上行および下行結腸にアフタ様潰瘍を認め，大腸Crohn病と診断した．salazopyrin単独投与による治療を4年間続け，臨床症状およびX線所見も著明に改善されたため，休薬して経過観察を行っているが，1年後の現在再発の徴候は認められず，X線および内視鏡所見も横行結腸に線状縦走潰瘍瘢痕像を残すのみとなっている．

　A case of colonic Crohn's disease was reported, which did not show any aggravation for five years and kept remission state at least for recent one year. The patient was a 28 year-old man and visited our hospital with the complaint of mucous stool and upper abdominal pain.

　On admission, a tumorous mass in the upper abdomen and fistula ani were recognized by physical examination.

　Barium enema and endoscopic findings revealed longitudinal ulcers and cobblestone appearance in the transverse colon. Aphthoid ulcers were also seen in the ascending and descending colon, and a diagnosis of colonic Crohn's disease was made.

　The clinical symptoms and x-ray findings were improved remarkably by Salazopyrin administration for four years. The remission state has been kept without any medical treatment for recent one year.

　The latest x-ray and endoscopic examination showed a few longitudinal ulcer scars only limited in the transverse colon.