Crohn's disease and carcinoma of colon.
Crohn's disease and carcinoma of colon.
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克罗恩病和结肠癌。
DOI：
10.1136/bmj.2.5603.466
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发表时间：
1968
影响因子：
--
通讯作者：
G. Massarella
中科院分区：
文献类型：
--
作者：
A. Perrett;S. Truelove;G. Massarella
1949年10月，一位34岁的家庭主妇第一次住进拉德克利夫医院。她提供了8个月腹泻和体重减轻的病史，以及2周下腹部疼痛的病史。她消瘦，右髂窝可触及肿块。调查。血红蛋白7.2克/ 100毫升血膜标记的缺铁变化。粪便-隐血反复阳性，病原体阴性，培养无抗酸杆菌。钡剂灌肠显示盲肠不规则的充盈缺损，以及盆腔结肠的一小段狭窄。在1949年11月手术的外观是盲肠的恶性病变，乙状结肠和末端回肠线圈粘附。进行右半结肠切除术、回肠切除术和乙状结肠切除术，左结肠端端吻合术和端侧回肠横结肠吻合术。盲肠包含一个大的软癌，已部分浸润盲肠壁。盲肠与上覆回肠袢之间存在粘连。组织学肿瘤是一个中等分化的乳头状腺癌。显微镜下，一些粘连本质上是炎性的，而另一些是肿瘤性的。盲肠内的混合炎性浸润远远超出了肿瘤的范围，并且在这种浸润内是含有巨细胞的肉芽肿灶。结肠周围脂肪有明显的粘膜下纤维增厚和纤维浸润，并存在裂隙。回肠内再次出现明显的浆膜下和粘膜下纤维增厚，粘膜下含有斑片状混合炎性浸润，包括中等数量的巨细胞。增大的肠系膜淋巴结显示明显的反应性增生，但没有恶性肿瘤的证据。总之，这些变化是涉及盲肠和回肠的克罗恩病的典型变化。手术后，患者乙状结肠切除部位出现粪瘘，但最终闭合，入院后3个月出院回家。四个月后，由于瘘管复发，她再次入院。这是切除和缺陷的结肠关闭。她七年来一直很好
A housewife was first admitted to the Radcliffe Infirmary in October 1949 at the age of 34. She gave a history of eight months' diarrhoea and loss of weight, and two weeks' history of lower abdominal pain. She was emaciated and a mass was palpable in the right iliac fossa. Investigations.-Haemoglobin 7.2 g./100 ml. Blood filmmarked iron-deficiency changes. Stools-repeatedly positive for occult blood, negative for pathogens, no acid-fast bacilli on culture. Barium enema showed an irregular filling defect of the caecum, together with narrowing of a short segment of the pelvic colon. At operation in November 1949 the appearances were those of a malignant lesion of the caecum, to which the sigmoid colon and coils of terminal ileum were adherent. A right hemicolectomy, ileal resection, and sigmoid resection was carried out, with end-toend anastomosis of the left colon, and end-to-side ileotransverse colostomy. The caecum contained a large soft carcinoma which had partially infiltrated the caecal wall. There were adhesions between caecum and overlying loops of ileum. Histologically the tumour was a moderately differentiated papillary adenocarcinoma. Microscopically, some adhesions were inflammatory in nature and others were neoplastic. A mixed inflammatory infiltrate within the caecum extended well beyond the limits of the tumour, and within this infiltrate were granulomatous foci containing giant cells. There were marked submucosal fibrous thickening and fibrous infiltration of pericolic fat, and fissures were present. Within the ileum there was again pronounced subserosal and submucosal fibrous thickening, and the submucosa contained patchy mixed inflammatory infiltrate, including moderate numbers of giant cells. Enlarged mesenteric lymph nodes showed marked reactive hyperplasia but no evidence of malignancy. In summary the changes were typical of Crohn's disease involving the caecum and ileum. After the operation the patient developed a faecal fistula from the sigmoid resection site, but this eventually closed and she was discharged home three months after admission. She was readmitted four months later because the fistula had recurred. This was excised and the defect in the colon closed. She remained well for seven