국한성 장염의 임상 고찰

Abstract

We had experienced 17 cases of Crohn's disease pathologically proved for the past 20 years from 1972 to 1992 at surgical department of St. Benedict hospital and reviewed and analyzed clinically all of the medical records with results as follows. 1) Male to female ratio was 1 ： 0.9 2) Over half of the cases were noted below the age of 40 years whereas most of the Caucacians were noted younger than our cases. 3) The common symptoms were abdominal cramp, epigastric discomfort, anorexia, bowel habit change, weight loss, febrile sense and rectal bleeding in orders. 4) The common physical signs were abdominal tenderness, distension, rebound tenderness, palpable mass in RLQ and rigidity in orders. 5) Intestinal obstruction was the most common preoperative diagnosis. 6) Most of all the lesions were in small intestines, especially in ileum, 3 cases in small and large intestines and 2 cases in colon. 7) Macroscopic findings were edema and thickening of bowel wall, segmental stenosis with proximal dilatation, thickening of mesentery, serosal exudate, fat creeping and skip areas in orders. 8) Microscopic findings were submucosal edema, ulcer of mucosa, lymphoid hyperplasia granuloma, fibrotic change and crypt abscess with infiltration of inflammatory cells. 9) Operative procedures were as follows； segmental resections(13 cases), right hemicolectomy(2 cases), limited multiple resection(1 case) and sigmoid colectomy with Hartman's colostomy(1 case). 10) We experienced eleven cases of complicated Crohn's disease； seven cases of intestinal obstruction, two cases of intestinal perforation, one case of massive hemorrhage and one case of ileal fistula transfered from other surgical clinic. 11) There were two cases of postoperative complications； one is intestinal obstruction, the other is leskage on anastomotic site.