非特異的炎症により下部直腸の全周性狭窄をきたした1切除例 Nonspecific Inflammatory Stenosis of the Rectum : Report of a Resected Case

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直腸狭窄の原因には腫瘍,隣接臓器・組織による圧排,炎症性腸疾患,性病,放射線・虚血・座薬使用・肛門性交などによる直腸炎,直腸間膜脂肪織炎があるが,非特異的炎症による直腸狭窄症の切除例の報告はきわめて少なく,検索し得た範囲では本邦においては本症例が最初である.症例は61歳の男性で,1年前より次第に増強する排便困難感のため1995年5月に精査を受け,下部直腸の全周性の狭窄を指摘された.7月にS状結腸に人工肛門造設術を受けたが確定診断に至らず,悪性腫瘍も否定できなかったため9月25日に腹会陰式直腸切除術を行った.切除標本の組織学的検査では粘膜下層,固有筋層に厚い線維組織と密な慢性炎症細胞の浸潤を認めた.本症例は術前の画像診断,手術所見,組織検査より除外診断を行い,非特異的炎症による直腸狭窄と診断した.粘膜下層,固有筋層主体の壁肥厚による直腸の全周性の狭窄は非特異的炎症が原因になることもあり得る.

Rectal stenosis is usually caused by neoplasms, compression from adjacent organ and tissue, inflammatory bowel disease, sexually transmitted disease, and proctitis due to radiation, ischemia, abuse of suppositories, and rectal intercourse. Rectal stenosis due to nonspecific inflammation is quite rare. Here a patient with such rectal stenosis is presented.<BR>A 61-year-old male had distress of evacuation for one year. The symptom gradually deteriorated until the presence of rectal stenosis was indicated in May 1995. Colostomy was established at the sigmoid colon in July 1995. Since a definite diagnosis could not be made even by repeated mucosal and submucosal biopsy and a malignant disease could not be denied, abdominoperineal resection was performed two months after the first operation. In the resected specimen, narrowing of the lower rectum, 9.5cm in length, was noted with smooth mucosa and thickened wall. A histological examination showed thick fibrosis and dense infiltration of chronic inflammatory cells in the submucosal and proper muscle layers. The diagnosis was stenosis due to nonspecific inflammation. To the best of our knowledge, there has been no previous report of such a patient in Japan.

収録刊行物

  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 50(2), 120-124, 1997-02-01

    The Japan Society of Coloproctology

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各種コード

  • NII論文ID(NAID)
    10008438868
  • NII書誌ID(NCID)
    AN00195100
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    00471801
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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