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KMID : 0371319640060030121
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Journal of the Korean Surgical Society
1964 Volume.6 No. 3 p.121 ~ p.131
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Crohn´s Disease
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金光演/Kim, Kwang Yun
徐相賢/張明煥/閔光植/Suh, Sang Hyon/Chang, Myung Whan/Min, Kwang Sik
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Abstract
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This article is to report the results of analysis and evaluation of the twelve cases of Crohn´s disease experienced at surgical department of Severance Hospital during past 5 years from 1958 to 1963 with review of the pertinent articles.
Since the report of "Regional ileitis" described by Crohn, Ginzburg and Oppenheimer, in its pathologic and clinical details, as a disease entity of the terminal ileum, the similar pathologic changes have been found to involve in all part of the gastrointestinal wall including the duodenum, stomach and large bowel as well. The present study, however, showed that the lesion is, at least in Korean patients, more frequently found in the large bowel than in the terminal ileum.
Among 12 cases in this study both sexes were equally affected, 6 males and 6 females. Average age was 38 and the onset occurred befor 40 years of age in 10 cases.
The pathological changes were located in the terminal ileum in 3 cases, ileocecal region in 3 cases and large bowel alone in 6 cases. Among 6 cases who had the lesion in the colon alone, 2 cases were in the cecum, 1 in hepatic flexure and splenic flexure respectively and 2 in rectosigmoid region.
There was no demonstrable etiological factor, however, E. coli was isolated in 3 cases and streptococci in 2 cases, and there were 3 cases probably related with psychotic background.
There was one patient who had a complication of fistula in abdominal wall, but no complication of anal fistula or fissure was noted. Palpable mass was the most common physical sign, found in all 9 cases of the large bowel involved. These masses were due to either edematous thickening of bowel wall or localized paracolic or retrocolic abscess caused by chronic perforation.
The usual subjective symptoms were long standing indigestion, low grade fever and abdominal pain and distension.
By Roentgenography, so called string sign was noted in 2 cases whose lesion was localized in the terminal ileum, and in cases of large bowel involvement segmental intramural narrowing, stricture or flattening of haustra were common findings. Since the mass was palpated in all cases of large bowel involved malignant tumor especially cancer had to be differentiated.
Grossly, involved bowel showed sharply demarkated area of thickening, regidity and redness with chronic perforation in two third of the tumoral type of the large bowel cases.
Microscopically, interstitial edema, obstruction or ectasia of the lymph duct, lymphoid hyperplasia, endothelial proliferation and perivascular histiocytosis were noted more frequently in submucosa with subacute or chronic cellular infiltration in whole layers of the intestinal wall associated with lymphocytic aggregation extending to muscular layer.
Crohn´s disease may be better managed by conservative medical treatment unless the complications such as perforation, hemorrhage, intestinal obstruction and fistula formation supervene, or progressive deteriolating symptoms or postoperative recurrence is noted. In the present series, 9 cases were surgically treated because of incomplete intestinal obstruction associated with palpable mass. and 3 cases were explored because of progressive symptomatic ileitis, one of which had postoperative fistula formation. Surgical procedures applied in these 12 cases are as follows: in 2 cases of the terminal ileum involved bypass procedure of end-to-side ileotransverse colostomy was performed after transectlon of the ileum at 50~60 ㎝ above the proximal margins of the lesion, in cases of the rectosigmoid involved wide resection of the leison was performed 1 and 1 1／2 years after primary colostomy respectively and in the rest of the cases primary resection of the lesion was carried out.
There have been no recurrence yet in 2 to 5 year follow-up study except one case of the rectosigmoid involved.
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KEYWORD
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