範囲の発赤のみを呈し約8か月後に縮小をみた直腸のmucosal prolapse syndromeの1例

Mucosal Prolapse Syndrome of the Rectum with Reddening in a Small Area and Reduction of Size after Eight Months, Report of a Case

要旨　患者は58歳男性で，主訴は便に粘液が付着することであり，排便時間が長く，また，いわゆるstrainerであった．注腸X線検査では異常なかった．大腸内視鏡検査で下部Houston弁直上の前壁寄りに，大きさが約2.0×0.5cmの長円形の発赤した領域を認めた．鉗子生検により，特徴的なfibromuscular obliterationの所見を得，直腸のmucosal prolapse syndrome（いわゆるsolitary ulcer syndrome of the rectum）と診断した．その後，この小病変は排便時間を短縮することによって，約8か月後に長径が約1.0cmに縮小した．これらのことにより本症における初期病変は，小範囲の平坦で発赤した異常であり，経時的に変化し粗大病変へと増悪したりあるいは縮小したりするものであることが予測された．

　The patient was a 58 year-old man with complaints mainly of mucus stool and elongated defecation time. He was a so-called strainer. Enema disclosed no abnormality. Colonoscopic examination revealed a reddened oval area measuring approximately 2.0×0.5 cm in size along the anterior wall above the lower Houston valve of the rectum. Forceps biopsy disclosed characteristic fibromuscular obliteration and a diagnosis of mucosal prolapse syndrome of the rectum (so-called solitary ulcer syndrome of the rectum) was made. The patient was instructed to reduce the defecation time and “straining” and, about eight months later, the lesion (as disclosed by endoscopy) was reduced to about 1.0 cm in its major axis.

　It was suggested that this syndrome showed at the initial stage a flat reddened abnormality in a small area and changed either into a larger aggravated lesion or was reduced in size, with the passage of time.