糖尿病維持透析患者に発症した直腸炎の１例

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  • Proctitis in a diabetic patient undergoing chronic hemodialysis: a case report
  • ショウレイ ホウコク トウニョウビョウ イジ トウセキ カンジャ ニ ハッショウ シタ チョクチョウエン ノ 1レイ

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We report a case of proctitis developed in a diabetic patient receiving chronic hemodialysis. A 69-year-old Japanese woman with an approximately 22-year history of type 2 diabetes mellitus, and she had initiated maintenance hemodialysis at 60 years of age (October 1995). She had also experienced ectopic pregnancy treated surgically at 25 years of age. The patient had been unable to walk for several days due to progressive coxalgia, so that she had been admitted to the dialysis clinic on July 1, 2004. White blood cell was 25, 600/μL on July 7, and she was transferred to our hospital on July 12. On admission, hemoglobin Alc was 7.7%. Although the patient complained of severe coxalgia, pelvic magnetic resonance imaging and computed tomography examinations demonstrated normal-appearing hip joints and circumferential thickening of the rectal wall. Colonoscopy demonstrated mucosal hemorrhage and erosions, localized from the dentate line to 4-7cm. After proctitis was diagnosed, the patient was started totally-parenterally nourished, and antibiotics were administered. Although the symptoms, endoscopic and radiographic findings improved after treatment, the disease flared twice during the following 3 months. Therefore, we continued parenteral alimentation for 21 days then for the following 54 days the patient was given a liquid diet and antibiotics were administered for 45 days. Thereafter, she entered remission. The origin of the proctitis was obscure, but there has not been any apparent episode of recurrence to date.

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