S状結腸切除術後の虚血性直腸炎の1例 [in Japanese] A CASE OF ISCHEMIC PROCTITIS AFTER SIGMOIDECTOMY [in Japanese]
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症例は59歳の男性. 3年前にS状結腸癌でS状結腸切除+D3郭清を受けた.平成11年3月24日より肛門痛が出現.下部消化管内視鏡でS状結腸切除の吻合部から肛門管にかけ粘膜は発赤し,白苔を有する潰瘍が多発していた.しかし吻合部より口側の粘膜には異常を認めなかった.骨盤部のCTでは直腸壁の肥厚と周囲のdirty fat signが認められた.内視鏡下の生検の組織学的検査で,好中球の浸潤と出血,浮腫が認められた.虚血性直腸炎と診断し中心静脈栄養管理したが軽快せず,横行結腸人工肛門を造設した.症状は術直後より軽快し,内視鏡所見でも正常所見になったため,人工肛門造設後6カ月で人工肛門閉鎖を行った.術後8カ月が経過しているが再発の兆候はない.
A 59-year-old man was seen at the hospital because of anal pain which occurred on March 24, 1999. There was a previous history of undergoing a sigmoidectomy with D3 lymph nodes dissection 3 years earlier. Lower gas-trointestinal endoscopy revealed redness on the mucosa covering from the anastomosis to anal canal and multiple ulcers with fur. But no abnormalities were observed on the mucosa anal side from the anastomosis. Pelvic CT scan visualized thickening of the rectal wall and dirty fat sign in the periphery. Endoscopic biopsy cytology revealed infiltration of neutrophile, hemorrhage, and edema. Ischemic proctitis was diagnosed. Total parenteral nutrition central venous catherization was started, but no remission was obtained. Artificial anus was made on the transverse colon. Clinical symptoms were relieved immediately after the operation and endoscopic findings came to normal. So the artificial anus was closed 6 months after its construction. There have been no signs of recurrence as of 8 months after the operation.
- Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 62(3), 748-751, 2001-03-25
Japan Surgical Association