術後7年6ヵ月間にわたり経過観察中のCrohn病の1例

Recurrent Crohn's Disease in Which Follow-up Observations Extending over Seven and a Half Years Were Made, Report of a Case

要旨　過去22年間に5回の腸切除術を受けた44歳男性のCrohn病患者の，最終手術後7年6カ月間の吻合部の再発所見について報告した．手術後2年4カ月目に吻合部に数個の不整形潰瘍を生じたが，ステロイド剤，salicylazosulfapyridineの投与によって保存的治療を試みた結果，炎症の増悪，緩解を繰り返しながら緩解期に導入することができた．最近の粘膜像は腸結核の治癒期の萎縮瘢痕像とも類似しており，Crohn病と他の炎症性腸疾患との鑑別上の困難さがうかがえた．

　The results of the follow-up observations extending over seven and a half years of recurrent Crohn's disease were reported. The patient was a 44 year-old man with Crohn's disease who had undergone surgical interventions five times during the last twenty-two years. He developed a few ulcerative lesions with an irregular margin at the site of the anastomosis twenty-eight months after the last operation, for which conservative therapy with corticosteroid and saliclyazosulfapyridine was initiated. Follow-up observations repeated thereafter revealed fluctuation of the inflammatory picture and the control of the disease was extremely difficult but remission was achieved at last. The mucosal appearance observed recently shares some similarity with that of atrophic scarring seen in the healing stage of intestinal tuberculosis, which suggested the difficulty in differentiating Crohn's disease from other inflammatory bowel diseases.