基礎疾患,誘因なく発症した急性直腸粘膜病変の1例 A CASE OF ACUTE RECTAL MUCOSAL LESION WITHOUT BASIC DISEASE AND INDUCEMENT IN THE BACKGROUND

症例は65歳,男性,主訴は新鮮血下血,既往歴は33歳より両側白内障で全盲,現病歴は1989年5月25日朝,コップ1杯程の下血あり,以後,2回下血が続き,同日緊急入院した.大腸内視鏡検査では肛門輪より5cmの部位に露出血管を有する不整形潰瘍を2カ所認め,1方は口側に縦走潰瘍を形成,保存的療法にて再出血はなく,第14病日に潰瘍は搬痕化した.本例は重篤な基礎疾患や発症誘因と考えられるものを認めないので河野らの命名した急性出血性直腸潰瘍には相当しないが類縁疾患と考えられる.これら急性に発症する直腸の潰瘍性病変はその発症機序に不明な点も多く,その病態が解明されることが期待されるが,今後これらの疾患を急性直腸粘膜病変として一括して取扱うことを提唱したい.

A 65-year-old male patient complained of fresh melena. He became completely blind because of bilateral cataract at 33 years old. On May 25, 1989, the patient had a cup of melena. Hemorrhage recurred twice after initial evidence and he was hospitalized. Hematological examination revealed anemia, showing Hb value 10.3 g/dl. Colonoscopy disclosed two irregular ulcers with visible blood vessels at 5 cm from the anal ring. Longitudinal ulcer was formed on the oral side in one lesion. Hemorrhage was stopped with conservative treatment. Ulcer developed scar formation on the 14th hospital day. This case is not acute hemorrhagic rectal ulcer proposed by Kohno et al. since there were no severe basic diseases or inducements in the background. However, elucidation of the mechanism of these acutery developing rectal ulcer lesions is expected, and we would like to propose to deal with such lesions collectively as acute rectal mucosal lesions.