INITIAL LESIONS IN COLONIC CROHN'S DISEASE

概要

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We report three cases of colonic Crohn's disease (CD), in which total colonoscopy at the initial visit revealed right colon-predominant sub-diffuse colitis of the entire colon, and biopsy of the lesion revealed non-caseating epithelioid cell granulomas. All the three cases lacked the standard CD lesions, including longitudinal ulcers and cobblestone appearance, but showed areas of longitudinal redness and a roughened mucosa with loss of the visible vascular pattern, with no ulcers, aphthae or inflammatory polyps. The closer these mucosal inflammations were to the oral side of the colon, the more significant they were, and the closer they were to the anus, the milder they were. There were no lesions in the upper gastrointestinal tract, small intestine or anus. Longitudinal ulcers and a cobblestone appearance of the mucosa developed after 13 to 18 months in one case, progressing thereafter to standard colonic CD. In another of the cases, the Bauhin valve showed new ulcer formation, and in the third, the endoscopic findings generally remained constant. We have appended a literature review and emphasize the need to recognize colitis, as different from aphtha, characterized by right-predominant longitudinal redness and loss of the visible vascular pattern of the mucosa, as the initial lesions of Crohn's disease.