KRONE DISEASE

From Big Medical Encyclopedia

KRONE DISEASE (Century V. of Crohn, amer. doctor, sort. in 1884) — the nonspecific infectious inflammatory process striking various departments went. - kish. a path from a gullet to a rectum. On localization of process distinguish: granulematozny gastritis, granulematozny enteritis, granulematozny ileocolitis, granulematozny colitis, granulematozny esophagitis, regional ileitis, terminal ileitis. Are surprised a small and large intestine more often.

M of X. Levitan et al. (1974) of 1000 patients with various nonspecific inflammatory damages of intestines at 83 was observed To.

In 1769 J. Morganyi described the nonspecific infectious and dystrophic process of various departments which is seldom found at a section research went. - kish. a path, served as a cause of death. At the beginning of 20 century some patients with such diseases were operated without exact preliminary diagnosis. The resection of an affected area was usually made.

In 1932. Kroner with sotr. described under the name of a regional ileitis of 14 observations at which the limited nonspecific inflammation of terminal department of a small bowel took place. Kroner devoted it a number of researches, including twice (1949, 1958) the published monograph owing to what in domestic and foreign literature the name «disease Krone» took roots.

The etiology

the Aetiology is not established. There is a number of theories: infectious — penetration into a wall of body in the enterogenous or metastatic way of microbes, preferential a streptococcus, an enterokokk, Yersinia enterocolitica, etc.; traumatic; allergic; autoimmune; theory of venous thrombosis; limf, a staza, etc.

Pathological anatomy

the Pathological anatomy is defined by nonspecific inflammatory process which can arise in any part of a digestive tract. The picture morfol, changes depends on localization of process, a stage of development and complications. At damage of a small or large intestine macroscopic (including and at a laparoscopy) the picture consists of such signs as puffiness and a thickening of an intestinal wall, hyperemia (see), emergence of small hemorrhages (see. Hemorrhage ) and fibrinous exudate (see) on a serous cover, and also regional lymphadenitis (see). Owing to a thickening of walls and narrowing of a gleam the affected area of a gut can look deformed that is described sometimes as «a symptom of a hose». Characteristic for To. the combination longwise of the directed narrow deep ulcer defects with the cross slit-like ulcerations delimiting the remained sites of a mucous membrane of a gut (a so-called picture of a cobblestone road) is. Very often at K.b. in the field of an anus there are cracks which are followed by an inflammation, ulcers and fistulas.

Irrespective of in what place of a digestive tract basic process, a picture of microscopic changes developed at To. it consists of manifestations nonspecific inflammations (see), having some features. The inflammation and inflammatory and cellular infiltration extend to all layers of an intestinal wall. The mucous membrane can remain not changed, cellular infiltrate is localized preferential in a submucosa. Vospalitelnokletochny infiltrate at To. consists of lymphocytes, plasmocytes and histiocytes; impurity of eosinophilic granulocytes is possible. Accumulations of lymphocytes quite often have an appearance of neogenic lymphoid follicles. It is shown that a considerable part of lymphocytes belongs to populations of T-system.

The productive component of an inflammation is expressed by also characteristic granulematozny reaction which is shown the fact that against the background of lymphoid and histiocytic infiltration there can be accumulations of epithelial cells and be formed the large multinucleate cells similar to colossal cells of Langkhans. These granulomas are not exposed to caseous transformation and can be found both in sites of the struck gut, and in fabrics on the course of distribution patol, process — in walls of the fistular courses and regional limf, nodes.

Ulcer defects (see. Ulcer ), having at To. character of narrow cracks, get deeply into a wall of a gut, reaching sometimes a subserous layer. From a surface of an ulcer are covered with a thin necrotic coat, under the Crimea granulyatsionny fabric is located. Destructive and ulcer changes and an inflammation cause emergence of complications. A typical complication are commissures, sometimes with formation of conglomerates of loops of a small bowel. Often there are various internal (usually interintestinal) and outside fistulas. Perforation in a free abdominal cavity are observed seldom because of development of a commissural serositis.

Inflammatory and necrotic defeat of this or that site went. - kish. a path at To. is followed usually by such changes as expansion limf, vessels and limfangiit (see), reorganization of a mucous membrane of guts with deformation of crypts and widespread damage of microvillis, development of nevromopodobny educations.

The clinic and a current

the Disease not only on localization, but also on a current can be expressed in various forms. The acute form is similar to enterogenous phlegmons went. - kish. a path, described by M. G. Cherepashints (1956) and M. D. Moiseenko (1958). The disease proceeds usually with moderate pain in various departments of an abdominal cavity, often bloody ponosa, subfebrile temperature, a moderate leukocytosis, increase in ROE.

Upon transition of an acute form in chronic (apprx. 10%) or at the primary and chronic slowly progressing process which sometimes lasts many years and takes almost all large intestine or a considerable part thin in an abdominal cavity dense infiltrates are formed. Some forms hron. To. received the name of a granulematozny esophagitis gastritis, ileitis colitis, ileocolitis. In some cases hron, anal fissures and pararectal fistulas can be manifestation To.

The disease can proceed asymptomatically in the beginning. At a long current (years, decades) infiltration of walls can extend on an extent of all small or large intestine. Sooner or later there are a wedge, manifestations and various local complications and the general changes. Local complications — perforation of a gut in an abdominal cavity therefore can develop peritonitis (see), perforation in the next body — internal fistula (see. Intestinal fistulas ), intra intestinal bleeding (see. Gastrointestinal bleeding ), commissural processes (see. Adhesive desease ), paralytic dilatation of a gut or formation of the infiltrates reminding tuberculosis or parasitic (an echinococcus, an actinomycosis) processes, and also malignant new growths. The general changes have the intoksikatsionno-allergic nature. Dystrophic processes in internal parenchymatous bodies, changes of blood — anemia, a hypoproteinemia, a disproteinemia, reduction of quantity of microelements in blood, high ROE and the increased coagulability of blood, nonspecific defeat of joints of rhematoid type of extremities and a backbone, damage of eyes in the form of a keratitis, helcomas, irites, iridocyclites, episclerites concern to them, purulent and granulematozny processes in skin — eczema, a pyoderma, a furunculosis, a nodal erythema, etc.

the Diagnosis

the Diagnosis is difficult. At an acute terminal ileitis quite often make the diagnosis — acute appendicitis (see) also operate the patient. At hron, the course of a disease the diagnosis about a nek-swarm of shares of probability can be made on the basis of the described symptoms, data rentgenol, researches, results of endoscopy.

Fig. 1. The roentgenogram of intestines at a disease Krone: sharp uneven narrowing of a terminal part of an ileal gut with roughness of its contours.
Fig. 2. The roentgenogram of a cross colon at a disease Krone: haustration of a gut is absent, contours of a gut uneven, gear with spikulopodobny ledges.

The leader rentgenol, a symptom To. narrowing of an affected area of a gut (fig. 1) is. At sharp narrowing the struck department of a gut takes a form of «cord» or «string». If the caecum and a terminal part ileal are exposed to such change, then it is difficult to define the field of ileocecal transition. The changed fragment of a gut usually is not filled with hardly contrast weight, especially in the period of an exacerbation of a disease. The relief of a mucous membrane has polipovidny character. At defeat To. a large intestine of a gaustra smooth out or disappear. Contours of an affected area of a gut most often happen small - or krupnozubchaty, is frequent with characteristic for To. sharp-pointed spikulopodobny ledges (fig. 2) which are display of the slit-like ulcerations which are cross located and deeply getting into a wall of a gut. Sometimes ulcers, extending in depth of a wall of a gut, cause a peculiar picture of «hats of the nails» which are located with the correct ranks on contours of the affected skin on roentgenograms. Important sign is shortening of the changed pieces of a small or large intestine. The border with healthy sites of a wall of a gut is more often sharp. It is characteristic for To. alternation of the struck fragments of a gut with normal.

Changes of a mucous membrane radiological are shown by large or close-meshed structure of an inner surface of the gut reminding a cobblestone road. Against the background of the reconstructed relief of a mucous membrane resistant contrast spots, various in size — display of longitudinal and cross ulcers and erosion can be found.

Fig. 3. The roentgenogram of a large intestine at a disease Krone: the relief of a mucous membrane of the left half of a gut has cellular character (it is specified by shooters).

At a double contrast study of a gut (a suspension of barium and air) narrowing of an affected area of a gut, roughness of its contours, pseudo-diverticular protrusions, rigidity of walls, sharpness of borders decide on normal walls, a cellular structure of a relief of a mucous membrane (fig. 3) more clearly. At the differential diagnosis it must be kept in mind the following diseases: ulcer nonspecific colitis (see), hron, colitis of other etiology (see. Colitis ), tumors, a diverticulitis, tuberculosis, an actinomycosis (see. Intestines ), sarcoidosis (see), a venereal lymphogranuloma (see. Lymphogranulomatosis pakhovy ). In differential diagnosis To. with ulcer colitis it is necessary to consider that at ulcer colitis distal departments of a large intestine are surprised more often. Pseudopolypuses at the same time, in contrast To., are located randomly, have irregular shape and indistinct outlines. Narrowing of a gut develops less often and later. The cicatricial and stenotic form of tuberculosis of intestines is characterized by considerable wrinkling of an affected area of a gut, existence of the expressed commissures, increase mesenteric limf, nodes, unstructured reorganization of a mucous membrane of a gut, expressed funkts, frustration of the neighboring normal sites of a gut.

Treatment

Specific means for treatment To. it is not found. At acute forms apply antibiotics, streptocides, steroid hormones that leads to treatment or to transition to a chronic current. At a chronic current To., in addition to the mentioned drugs, appoint a symptomatic treatment (the diet and vitamin therapy, is carried out fight against anemia and other disturbances of composition of blood — a hemotransfusion, injection of proteinaceous and salt solutions), introduction of immunodepressants, recover function of intestines. In case of the operational treatment undertaken mistakenly concerning an estimated acute appendicitis at an acute form K. it is necessary to infiltrirovat a mesentery of a gut solution of an antibiotic and to sew up an operational wound without appendectomy since removal of a worm-shaped shoot at such patients quite often leads to development of intestinal fistulas.

At complications hron, forms of a disease — perforation, bleeding, the phenomena of impassability at the stenosing hems, infiltrates, dilatation — apply the radical surgical interventions which are usually consisting in a resection of considerable sites of a small or large intestine (see. Intestines, operations ).

The forecast at an acute form usually favorable. At hron, a current process can continue many years. Surgical treatment at complications, on different authors, gives from 13 to 30% of a lethality. Quite often, by data I. A. Kolosova (1975) in 20 — 45% of cases, after operational treatment arises a recurrence of a disease that results in need of repeated surgical interventions.



Bibliography: Aminev A. M. About interrelation of a terminal ileitis and Lane's excess, Vestn, hir., t. 87, No. 8, page 96, 1961; Belousov A. S. Differential diagnosis of diseases of digestive organs, page 146, M., 1978; Vitebsk Ya. D. About operational treatment of terminal ileitises, Surgery, No. 12, page 70, 1968, bibliogr.; Levitan M. of X., Abasov I. T. and To and p at l of l of e r L. L. Bolezn Krone, Baku, 1974, bibliogr.; F e to - V. D.'s ditch, etc. Disease Krone of a large intestine, Surgery, No. 6, page 140, 1974; Chukhriyenko D. P. and Bereznits-k and y Ya. S. Intra belly abscesses and phlegmons, Kiev, 1977; Shabanov A. N. and d river. About clinic and diagnosis of a disease Krone, Owls. medical, No. 1, page 100, 1972, bibliogr.; Shnigern. At. L. L. ikapuller X-ray-morphological parallels at a disease Krone of a large intestine, Klin, medical, t. 49, No. 1, page 110, 1971; Since about h n B. B. Regional ileitis, N. Y., 1949, bibliogr.; Crohn B. B. a. B e of g A. A. Right-sided (regional) colitis, J. Amer, med. Ass., v. 110, p. 32, 1938;

Crohn B. B., Ginzburg L. Oppenhei-m e r G. D. Regional ileitis, ibid., v. 99, p. 1323, 1932; K ant or J. L. Regional (terminal) ileitis, ibid., v. 103, p. 2026, 1934; Management of Crohn’s disease, Proceedings of the workshop of Crohn’s disease, ed. by J. T. Weterman a. o., Amsterdam — Oxford, 1976.


A. M. Aminev; M of H. Volgarev (stalemate. An.), H. U. Shniger (rents.).

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