⑦経過観察で確診できた大腸，回腸クローン病の1例

A Case of Crohn's Disease of the Colon and Ileum: Diagnosed case by follow-up study

　近年，わが国におけるクローン病への関心は極めて強く，1976年には日本消化器病学会の小委員会において診断基準案がまとめられるところとなった．しかし，この基準に合致しない所見を示す例も少なからずみられ，本疾患の診断には，なお幾つかの間題が残されている．

　ここに報告する症例は経時的に全大腸と回腸の一部が侵されたが，初発の下行，S状結腸の病変からはクローン病の診断をくだすことができず，4年後に回腸，5年後に横行結腸に出現した病変で確診できた例である．大腸のX線，内視鏡像および切除標本の肉眼像は多彩で，興味ある所見を示したので主として大腸の病変について若干の考察を加えて報告する．

　This case was diagnosed as Crohn's disease involving the whole colon and a part of the ileum, after five years of follow-up study.

　A 25-year-old man suffered from bloody stool and fever elevation since the age of eighteen. An initial lesion was located in the descending and sigmoid colon and was suspected of ulcerative colitis in spite of detailed X-ray, endoscopical and histological examinations. But an another lesion was found four years later in the ileum and then five years later in the transverse colon.

　By resected specimen, histological features of Crohn's disease were detected and the initial lesion was finally diagnosed as Crohn's disease retrospectively.

　The longitudinal ulcer lesion was found in the ileum and determined as resembling a typical structure of Crohn's disease of the small intestine in our country. But, X-ray picture and resected specimen of the colon showed peculiar findings. The roentgenologic features were narrowing with bilateral deformity, map-like ulcers. round-like niche, pseudopolyposis and collar-button sign. Among others the gross specimen of the transverse colon showed various findings, which involved the fusing of ulcers in some places, and it was suggested that these findings might indicate the peak stage of acute exacerbation of Crohn's disease.