非手術的に診断しえた直腸型Crohn病の1例

Non-Surgically Diagnosed Rectal Crohn's Disease, Report of a Case

要旨　排便困難および肛門部痛を主訴とした37歳，男性で，非手術的に直腸に限局したCrohn病と診断しえた1例を報告した．直腸型Crohn病の本邦報告例はこれまでに8例と少なく，非手術的に診断できたのは2例のみであった．本症の非手術的診断は容易ではないが，大腸X線検査および内視鏡検査による精密な診断と，生検材料の連続切片での詳細な検査が本症の診断率を向上させ，過大な手術侵襲を避けるのに有用と考えられた．

　A 37-year-old male was admitted to the hospital with complaints of anal pain and difficulty in defecation. Barium enema and endoscopic examinations revealed a remarkable stricture with cobblestone appearance and longitudinal ulcers in the rectum.

　Histopathologically, a non-caseating granuloma was found in the specimen including the entire layer of the rectum. Other parts of gastrointestinal tract were unremarkable by x-ray and endoscopy. These findings led to a diagnosis of rectal Crohn's disease.

　Rectal Crohn's disease is rare in Japan. During the past 18 years only eight cases including ours have been reported. Six cases of these were diagnosed as such only after resection or amputation of the rectum. Only two of eight have been comfirmed without operation. The mean age of all reported cases in Japan was 32.8, while it was 53.6±18 in the report of Williams et al.

　Differentiating rectal Crohn's disease from rectal carcinoma, tuberculosis, solitary ulcer syndrome and colitis cystica profunda is important, especially from tuberculosis in the rectum. Detailed histopathological study of full layer biopsy specimen as well as sophisticated x-ray and endoscopic examinations is essential to improve its diagnostic accuracy and to avoid unnecessary surgical intervention.