直腸肛門部の炎症性疾患―炎症性腸疾患の直腸肛門部病変

Anorectal Lesions in Inflammatory Bowel Disease

要旨　炎症性腸疾患に合併する直腸肛門部病変は，QOLに大きく影響を及ぼす病変として重要である．Crohn病では，直腸肛門部病変がCrohn病自体の潰瘍病変あるいはそこから発生した病変，すなわちCrohn病の合併症であるか，Crohn病自体には関連がなく，偶発的に通常の肛門病変がCrohn病の症例に生じたものかの鑑別が重要である．また近年，Crohn病に対する直腸肛門癌の合併が増加しており，その存在にも留意する必要がある．潰瘍性大腸炎にも頻度は低いものの痔瘻，肛門周囲膿瘍，直腸（肛門）腟瘻などが合併し，特に大腸全摘術を要する症例では，術式の選択を左右する場合がある．

　Anorectal lesions of patients with inflammatory bowel disease were presented in this paper. A variety of anorectal lesions occur in Crohn's disease patients with relatively high incidence. These lesions were considered by focusing on the basis of primary, secondary and incidental lesions. Primary lesions derive from the same inflammatory pathological processes that occur in the intestine. Secondary lesions arise from primary lesions and incidental lesions are those not related to Crohn's disease. This classification is useful for assessing anorectal lesions in relation to their clinical course and management.

　It should be noticed that the number of patients with anorectal carcinoma complicating Crohn's disease are increasing in Japan.

　Whereas the incidence of anorectal lesions of ulcerative colitis is low and most of them are incidental. The presence of anorectal lesion may change the operative procedure, if the patient needs surgical intervention.

　To maintain good quality of life for patients with inflammatory bowel disease, it is important to make precise assessment of the anorectal lesions and to select optimal management.