孤立性直腸潰瘍（Solitary Ulcer of the Rectum）の典型的な1例

A Typical Case of Solitary Ulcer of the Rectum: The first case report in Japan

　孤立性の浅い直腸潰瘍の患者を経験した．潰瘍によって強いテネスムスが生じ患者を苦しめ，難治性で，近位腸管に人工肛門を造設し便を遮断することにより軽快したが，人工肛門を閉鎖すると直ちに再発した．

　かかる疾患は本邦では未だ報告例がなく，欧米の小数の報告例で直腸の孤立性潰瘍（Solitary Ulcer of the Rectum）といわれる疾患で，しかも典型的な1例であることが分った．本症の本態は過誤腫であるともいわれているが決定的ではないようである．

　A 69-year-old male patient with complaint of severe tenesmus was found to harbor a solitary shallow ulcer in the lower rectum. Its surface, surrounded by reddened zone, was smooth and hard, akin to the peel of a melon. Pathological examination showed obliteration of the lamina propria by mixed collgaen and muscle fibers along with cellular infiltration.

　The ulcer was resistent to every kind of conservative therapy and once disappeared when fecal stream was diverted by colostomy, but reappeared soon after closure.

　This peculiar disease is called ‘solitary ulcer of the rectum’ by Madigan et al., and this is the first reported case in Japan. The etiology is supposed to be congenitally misplaced mucosal glands in the submucosal layer.