大腸のangiectasiaとangiodysplasia

Angiectasia of the Colon and Rectum

要旨　大腸における非腫瘍性の血管系の異常に関する定義は一定でない．後天的に形成された（と想定される）限局性血管拡張をangiectasiaとして，最近の10,000回の内視鏡において診断した48例を検討した．32例は単発であり，1例を除きクモ状血管腫様を呈し，全大腸に分布したが，横行結腸からS状結腸に高率であった．これらの血便のエピソードは5例であり，そのほかに出血源を思わせる病変はなかったが，内視鏡時には出血はなかった．2個以上存在した多発群16例では単発群に比し，高齢であり，5例に血便があり，クモ状血管腫様のものや限局血管怒張，その混在など多様で，2/3に肝硬変を合併していた．止血を必要としたのは2例のみであった．

　Definition of non-neoplastic vascular lesions of the colon and rectum has not been clear. Angiectasia, localized vascular dilatation, which seemed to be formed posteriorly was detected in 48 cases out of a recent 10,000 colonoscopies.

　Of these, 32 cases showed a single lesion. All except one of these showed vascular spider-like appearance and they were located from the cecum to the rectum, especially in the sigmoid and transverse colon. Only five cases had episodes of rectal bleeding but bleeding could not be verified in the other lesions in the colon. The remaining cases were diagnosed unexpectedly during surveillance after polypectomy or other symptoms. Multiple lesions exceeding two in number were found in the remaining 16 cases. These were found in rather elderly patients, and in comparison with the group with single lesions, they revealed vascular spider-like appearance and/or localized tortuous dilatation. Two thirds of these 16 cases had liver cirrhosis. Hemostasis was necessary in only two cases among the five cases who had episodes of rectal bleeding.