ENDOSCOPIC STUDY ON THE RECURRENCE OF CROHN'S DISEASE

Abstract

For the early diagnosis of Crohn's disease, it is important to investigate its early and / or initial lesions correctly. However, initial inflammatory involvement of Crohn's disease is scarcely inspected clinically. There are two methods for the substitution to know the early inflammatory changes of Crohn's disease; one is to inspect the small lesions which occur at the distant intestine from the main site of Crohn's disease and another is to investigate the early changes of the recurrence after the surgical excision. For these purposes, early mucosal changes of the recurrent Crohn's disease were examined endoscopically and radiologically. During the last 20 years, 6 patients with Crohn's disease were operated in our clinic. The initial anatomic involvement were (1) small intestine, 1 patient. (2) ileocolic, 4 patients and (3) colon, 1 patient. There were postoperative recurrences in 4 cases (66.7%); 1 case with the small intestinal pattern and 3 cases with the ileocolic pattern. All of the recurrence were seen at the anastomotic region ; a tiny aphthoid ulcer was inspected in Case 4 and solitary or multiple ulcers, in Case 1, 3 and 6. The anastomotic lesions were quite different from the typical macroscopical appearances of Crohn's disease (longitudinal ulcer with cobble-stone appearance). Skip lesions were detected in Case 1 and 6 about 1 year after the detection of the anastomotic lesions. The appearance of the skip lesions resembled the lesions that had occurred in the previously resected intestine. Therefore, it was supposed that the pathogeneses of the recurrence of Crohn's disease at the anastomotic area and skip area are somewhat different.