大腸クローン病の1例とX線診断

A Case of Crohn's Disease of the Colon and Its X-ray Diagnosis

　クローン病はCrohn，Ginzburg，Oppenheimerが1932年にregional ileitis¹⁾として発表し，回腸末端部を侵す小腸疾患と考えられていたが，現在では「消化管のどの部分をも侵すものである」²⁾ことが明らかにされている．しかし，小腸以外にもクローン病があるというこの現在の定説が一般に承認されるまでには多くの紆余曲折があり，永い停滞があった．

　Crohnの論文からまもない1934年には，Colpがクローン病は大腸も侵すことを発表した³⁾．Crohn，Rosenak⁴⁾（1936），Crohn，Berg⁵⁾（1938）は大腸クローン病と思われる症例を発表している．Rappaport（1951），Wells⁶⁾（1952），Warren⁷⁾（1954）などの先進的研究者の発表にもかかわらず，大腸のクローン病はなかなか認められなかった．

　We have encountered a case of Crohn's disease in a 25-year-old man who had lesions in the ileum, ascending colon and left-sided colon.

　Illustrated here are X-ray pictures of the patient, who had after all to undergo resection of the distal part of the ileum along with right colectomy because the ascending colon had increasingly shown stenosis despite management with oral administration of SASP (salicylazosulfapyridine), steroids enema and Imuran.

　The ileum showed a long linear ulcer and a creeping ulcer. The ascending colon displayed cobblestone appearance and inflammatory polyposis. The intestinal lumen was highly constricted. The left-hand side of the colon also showed a moderate degree of luminal constriction and marginal rigidity. Fine linear ulcers and partly fissuring ulcers were seen on the mucosal surface.

　We have found that these X-ray findings corresponded mostly well with those reported in the literature. However, we also confirmed that differentiation from colonic tuberculosis, reportedly a most difficult problem in the differential diagnosis, is impossible simply by broad findings such as the number of lesions, their way of distribution or changes in the intestinal contour. Minute changes of the mucosal surface around ulcers were found to be indispensable to the differential diagnosis.