過敏性腸症候群に合併し内科的治療が奏効した直腸粘膜脱症候群の1例

Mucosal Prolapse Syndrome Following Irritable Bowel Syndrome of Seven Years' Duration, Report of a Case of an Effective Treatment by Conservative Therapy

要旨　過敏性腸症候群（以下，IBS）と診断され治療を受けたが，症状改善のみられないまま7年経過後，直腸粘膜脱症候群（以下，MPS）を来しsalazosulfapyridine（以下，SASP）を含む内科的治療が有効であったと思われた1例を報告した．患者は17歳，男性．主訴はテネスムス，粘血便で，注腸造影，大腸内視鏡，超音波内視鏡検査，生検等よりMPSと診断された．治療として息み，排便回数を控えるよう心療内科的面接治療も行いつつ，緩下剤およびSASPの投与を行った．投薬開始1か月後に粘血便は消失し，2か月後には形態的にも著明な改善がみられた．MPSには長期のIBSの経過中にMPSを合併する例が含まれることが証明された症例と考える．

　A case of mucosal prolapse syndrome (MPS) of a 17-year-old male is reported. The patient had been followed up for seven years under the diagnosis of irritable bowel syndrome (IBS) without any significant therapy. He complained of tenesmus and had mucohematochezia, and was diagnosed as MPS by barium enema (Fig. 1), colonofiberscopy (Fig. 2) and ultrasonography (Fig. 4) etc. Rectal biopsy revealed fibromuscular obliteration (Fig. 3) confirming the diagnosis of MPS. By instructing the patient to refrain from straining and to void stool less frequently, and also by psychosomatic therapy, mild laxative and salazosulfapyridine (SASP), much improvement was seen after two months (Fig. 5). To our knowledge, this is the first case to prove that MPS (polypoid type) could occur in a natural course after a long history of IBS. It is also interesting that conservative therapy including SASP was effective in this case.