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局限于小肠的Crohn病和淋巴瘤,在临床和放射线表现上非常相似,有时会遇到诊断上的困难。如果病变位于十二指肠和近端空肠,则作近端小肠粘膜活检对诊断会有帮助;但位于远端小肠的病变,常需要剖腹探查才能确诊。过去的文献报道,直肠粘膜活检显示Crohn病特征的发现率很低(1～13％),故这一鉴别诊断方法并未受到重视。作者等在5例青年病人中遇到诊断上的困难,其中3例直肠活检支持Crohn病而避免了剖腹探查(例1～3),另2例仍经剖腹而确诊(例4～5)。病例摘要如下: 例1 14岁女孩。有腹痛、体重下降、疲倦、稀便计16个月。体检发育正常。有全腹压痛。实验室检查:血球压积32％,ESR50,白细胞7,500,其中多核62％,带状6％。白蛋白2.7g％,IgG2110mg％,IgA380mg％,IgM226mg％。粪便隐血阴性。胸片正常。钡餐检查:
Crohn’s disease and lymphoma, which are confined to the small intestine, are very similar in clinical and radiological manifestations and sometimes have diagnostic difficulties. If the lesion is located in the duodenum and proximal jejunum, then the proximal intestinal mucosal biopsy will be helpful in the diagnosis; but lesions located in the distal small intestine often require laparotomy to confirm diagnosis. In the past literature, the detection of rectal mucosal biopsy showed a very low incidence of Crohn’s disease (1 ~ 13%), so this differential diagnosis method has not been taken seriously. The authors encountered diagnostic difficulties in 5 young patients, 3 of whom underwent colorectal biopsy to support Crohn’s disease without laparotomy (cases 1 to 3) and the other 2 who were still diagnosed by cesarean section (cases 4 to 5). Case summary is as follows: Example 1 14-year-old girl. Have abdominal pain, weight loss, fatigue, loose stools 16 months. Physical examination is normal. Have full abdominal tenderness. Laboratory tests: hematocrit 32%, ESR50, white blood cells 7,500, of which 62% multi-core, 6% ribbon. 2.7 g% albumin, 210 mg% IgG, 80 mg% IgA, and 226 mg% IgM. Fecal occult blood negative. Normal chest X-ray. Barium meal examination: