直腸腟瘻と直腸膀胱瘻を合併したサイトメガロウイルス直腸炎の1例 A CASE OF CYTOMEGALOVIRUS PROCTITIS ASSOCIATED WITH BOTH RECTOVAGINAL AND RECTOVESICAL FISTULAE

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症例は86歳,女性.食欲不振,下痢で入院.大腸内視鏡検査(CS)で直腸粘膜発赤のほか,肛門から2cmの部位に腟内へ内視鏡を容易に挿入し得る程の大きな腟瘻と,8cmの部位に膀胱壁に接する大きな深い瘻孔を認めた.瘻孔からの生検標本に核内封入体を認め抗サイトメガロウイルス(CMV)抗体免疫染色も陽性で,血清抗CMV抗体IgGとIgMが高値より瘻孔合併CMV直腸炎と診断した.抗HIV抗体陰性,CD4/8比正常.入院3週後に糞尿あり,CSで肛門から8cmの瘻孔の底に2個の5-8mm大の開口を認め,それらを介して膀胱内腔が観察された.経尿道膀胱造影で造影剤が膀胱から瘻孔(2,5×4cm)を経て直腸へ,さらに直腸から腟へ流れた.ganciclovir投与と横行結腸に人工肛門造設術施行.2カ月後膀胱造影で造影剤の漏れは認めず,3カ月後のCSでは腟瘻は縮小し膀胱瘻は治癒していた.直腸腟瘻と直腸膀胱瘻を合併した健常成人発症CMV直腸炎症例は稀である.

An 86-year-old woman was admitted for anorexia and diarrhea (sometimes bloody diarrhea). Colonoscopy revealed proctitis associated with both a huge fistula, through which a scope was easily inserted into the vagina, and a huge deep one adjacent to the urinary bladder, 2 cm and 8 cm from the anus respectively. Histological examination of biopsy specimens from the fistula revealed intranuclear inclusion bodies, and positive immunostaining for cytomegalovirus (CMV) antigen. Serum levels of anti-CMV antibody IgG and IgM were elevated but no serum antigen of CMV was detected. She was diagnosed as having CMV proctitis with fistulae. Serum assay of anti-HIV antibody was negative and serum level of CD4/8 ratio was normal. Three weeks after admission she complained of fecaluria. Colonoscopy revealed 2 orifices, through which a lumen of the urinary bladder was observed, in the base of the huge fistula 8 cm from the anus. Transurethral cystography showed that contrast media in the bladder flowed out through a f istulous tract (2.5 cm in diameter and 4 cm in length) into the rectum and then from the rectum into the vagina. She was treated with ganciclovir for 2 weeks and received transverse colostomy. Two months later cystography, showed that no contrast media in the bladder leaked. Three months later colonoscopy showed that the rectovaginal fistula decreased in size and the rectovesical one diminished. To our knowledge three cases of a rectovaginal fistula due to CMV infection and no case of a rectovesical fistula due to CMV infection have been reported from 1983. This was a rare immunocompetent case of CMV proctitis with both rectovaginal and rectovesical fistulae.

収録刊行物

  • 日本消化器内視鏡学会雑誌 = Gastroenterological endoscopy  

    日本消化器内視鏡学会雑誌 = Gastroenterological endoscopy 48(8), 1577-1584, 2006-08-20 

    一般社団法人 日本消化器内視鏡学会

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各種コード

  • NII論文ID(NAID)
    10018786227
  • NII書誌ID(NCID)
    AN00192102
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03871207
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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