44年間の長期皮膚腸瘻の1例  [in Japanese] A Case of External ntestinal Fistula for 44 Years  [in Japanese]

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Abstract

大腸切除術後に発生し, その後44年間放置された皮膚腸瘻の1例を経験した.その治療から長期間空置された大腸と肛門の機能および組織学的変化を検討しえたので報告する.症例は 69歳の男性で腸瘻周囲の皮膚炎を主訴に来院した.大腸はS状結腸と直腸のみ残存し, 皮下にて回腸と吻合されており, その吻合部が皮膚腸瘻を形成していた.直腸生検では粘膜の慢性炎症細胞浸潤, 陰窩の乱れと萎縮, 粘膜表層のびらんが認められた.手術は, 腸瘻部を含めた腸管切除および回腸直腸吻合術を施行した.術後2か月間, 水様軟便がみられ, 廃用性の水分吸収機能障害によるものと考えられた.術後3か月の直腸生検では, 炎症所見は消失していた.肛門管最大静止圧は術前40cmH_2Oと低値であったが, 術後3か月で80cmH_2Oまで回復した.肛門の再使用により, 低下した括約筋機能が回復したと考えられた.######We encountered a case of external intestinal fistula that developed after resection of the colon and had been left untreated for 44 years. This report describes the functional and histological changes of the long-diverted large intestine and anus, detected during the treatment. The patient was a 69-year-old man who consulted our hospital with the chief complaint of dermatitis around the intestinal fistula. Only the sigmoid colon and rectum of the large intestine remained, and there was a subcutaneous anastomosis with the ileum, forming an external intestinal fistula. In the rectal biopsy specimen, mucosal chronic inflammatory infiltration, crypt distortion and atrophy, and surface erosions were detected histologically. We resected the intestinal segment containing the fistula and performed an ileoprotostomy. For two months postoperatively, aqueous soft stools were seen. This was presumably caused by dysfunction of water absorption due to disuse. Rectal biopsy performed three months later revealed that the inflammatory findings had disappeared. Though maximum resting pressure of the anal canal was as low as 40 cmH_2O before surgery, it had recovered to 80 cmH_2O three months postoperatively. It was thought that the decreased sphincteral function recovered as a result of reuse of the anus.

We encountered a case of external intestinal fistula that developed after resection of the colon and had been left untreated for 44 years. This report describes the functional and histological changes of the long-diverted large intestine and anus, detected during the treatment. The patient was a 69-year-old man who consulted our hospital with the chief complaint of dermatitis around the intestinal fistula. Only the sigmoid colon and rectum of the large intestine remained, and there was a subcutaneous anastomosis with the ileum, forming an external intestinal fistula. In the rectal biopsy specimen, mucosal chronic inflammatory infiltration, crypt distortion and atrophy, and surface erosions were detected histologically. We resected the intestinal segment containing the fistula and performed an ileoprotostomy. For two months postoperatively, aqueous soft stools were seen. This was presumably caused by dysfunction of water absorption due to disuse. Rectal biopsy performed three months later revealed that the inflammatory findings had disappeared. Though maximum resting pressure of the anal canal was as low as 40 cmH_2O before surgery, it had recovered to 80 cmH_2O three months postoperatively. It was thought that the decreased sphincteral function recovered as a result of reuse of the anus.

Journal

  • The Japanese journal of gastroenterological surgery

    The Japanese journal of gastroenterological surgery 31(12), 2392-2396, 1998-12-01

    The Japanese Society of Gastroenterological Surgery

References:  6

Codes

  • NII Article ID (NAID)
    110001330525
  • NII NACSIS-CAT ID (NCID)
    AN00192066
  • Text Lang
    JPN
  • Article Type
    SHO
  • ISSN
    03869768
  • Data Source
    CJP  NII-ELS  IR 
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