クローン病と上腸間膜動脈症候群が合併し、神経性食欲不振症との鑑別に苦慮した1例  [in Japanese] A Case of Crohn's Disease Associated with Superior Mesenteric Artery Syndrome Presenting as Anorexia Nervosa  [in Japanese]

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Abstract

症例は14歳の女子。食後の上腹部痛、悪心があるも、胃カメラなどでは著変がなかった。るいそうが顕著であったが、初潮前であり、肥満嫌悪や身体像のゆがみもなかったため、神経性食欲不振症の疑いとして経過を観察していた。微熱、頻脈、炎症反応が続き、免疫便潜血検査で陽性のこともあった。初診約1年後、上部消化管透視と腹部エコーにて上腸間膜動脈症状群の存在を認めた。開腹術を行ったところ、回腸末端部に縦走潰瘍があり、組織所見からクローン病と診断した。手術の1年半後に体重は23kgから42kgまで増加し、月経も発来した。クローン病と上腸間膜動脈症候群の合併症の報告は見当たらないが、両者ともに神経性食欲不振症に類似した臨床像をとることがあり、十分留意されるべきであろう。

A case of fourteen-year-old girl with postprandial abdominal pain, nausea and vomiting is presented. Gastroscopy and abdominal ultrasonogram did not reveal any major abnormalities, although the fecal hemoglobin concentration was increased. She was referred to the Dept. of Psychosomatic Medicine because anorexia nervosa was suspected. She was quite emaciated and had not entered menarche, but was without phobia of weight gain or distortion of body image. Low grade fever and tachycardia persisted and blood test showed an inflammtory reaction. Further studies, however, including barium enema and CT of the abdomen were non contributory. Almost one year after the initial consultation, she was hospitalized and superior mesenteric artery syndrome was noted on an upper GI series and abdominal ultrasonogram. As obstruction of duodenum at the superior mesenteric artery was severe, Iaparotomy was performed. At surgery, Iongitudinal ulceration of the terminal ileum was incidentally found. Histological examination confirmed Crohn's disease. Post-operatively, the gastrointestinal symptoms settled, and her weight increased from 23 kg to 42 kg over one and half years and regular menstruation has begun. To our knowledge, there has been no previously reported case of Crohn's disease associated with superior mesenteric artery syndrome, in which the combination presented as anorexia nervosa. This paper emphasizes that each of the disorders should be considered during the differential diagnosis of anorexia nervosa.

Journal

  • Japanese Journal of Psychosomatic Medicine

    Japanese Journal of Psychosomatic Medicine 36(6), 513-517, 1996

    Japanese Society of Psychosomatic Medicine

References:  6

Codes

  • NII Article ID (NAID)
    110001126509
  • NII NACSIS-CAT ID (NCID)
    AN00121636
  • Text Lang
    JPN
  • Article Type
    SHO
  • ISSN
    0385-0307
  • Data Source
    CJP  NII-ELS  J-STAGE 
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