肺がん患者に発症した急性出血性直腸潰瘍の1例  [in Japanese] Acute hemorrhagic rectal ulcer in a patient with lung cancer  [in Japanese]

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Abstract

【目的】急性出血性直腸潰瘍は長期臥床の高齢者に多い疾患であるが, がん患者での報告は少ない. 今回, 対麻痺の肺がん患者に合併した急性出血性直腸潰瘍の1例を報告する. 【症例】40歳代の男性. 肺がんの脊髄浸潤により対麻痺を発症し, 緊急入院となった. 第25病日より無痛性の新鮮血下血が始まり, 出血量が増加した. その後, 下部消化管内視鏡検査を施行し, 下部直腸に潰瘍性病変と露出血管を認めた. 臨床症状と内視鏡所見より急性出血性直腸潰瘍と診断し, ただちにクリッピング術を行った. その後は下血の再燃を認めず, 第103病日に退院となった. 【結論】急性出血性直腸潰瘍は終末期がん患者でも治癒しうる病態であり, 症例によって迅速な診断と治療が必要である. Palliat Care Res 2011; 6(1): 308-312

<b>Purpose</b>: Acute hemorrhagic rectal ulcer (AHRU) commonly occurs in elderly who are bedridden for long time due to severe underlying diseases such as cerebral and myocardial infarction and their complications. However, it is uncommon in end-stage cancer patients receiving palliative care. We report a rare AHRU case in his forties who had lung cancer with paraplegia due to tumor invasion. <b>Case</b>: A male lung cancer patient was admitted to our hospital for new-onset paraplegia caused by spinal cord invasion. On 25th day after admission, he suffered from a little rectal bleeding. From that day, a painless rectal bleeding becomes gradually increased. On 37th day, a massive bleeding was occurred. Endoscopy showed that there was no active bleeding but an exposed vessel and partial circumferential ulcer in the lower part of rectum, which was compatible with the finding of AHRU. The lesion was successfully treated by clipping and no re-bleeding was observed after clipping. He was discharge on 103rd day. <b>Conclusion</b>: AHRU should be considered in the differential diagnosis of a massive melena in end-stage cancer patients. Prompt diagnosis and therapy is important because this disease is curable even in the terminal stage to improve their quality of life. Palliat Care Res 2011; 6(1): 308-312

Journal

  • Palliative Care Research

    Palliative Care Research 6(1), 308-312, 2011

    Japanese Society for Palliative Medicine

Codes

  • NII Article ID (NAID)
    130000672257
  • Text Lang
    JPN
  • Data Source
    J-STAGE 
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