直腸粘膜脱症候群の内視鏡診断

Endoscopic Diagnosis of Mucosal Prolapse Syndrome of the Rectum

要旨　11例の直腸粘膜脱症候群（MPS）を内視鏡的に検討した．症例は若い女性に多く，症状は直腸出血と便通異常であった．内視鏡像は潰瘍形成の明らかなものと，潰瘍のないものに2大別できた．潰瘍は浅くて平坦，境界は明瞭．潰瘍底は白苔に覆われ，白苔は薄くて底の一部が露出しているものと，比較的厚いものと，辺縁部は平坦なものと，盛り上がっているものとがあった．非潰瘍型のものは粘膜の発赤を主体にしたものであったが，限局性のものとやや拡がりのあるもの（全周性を含む）とがあった．発赤型のものでは経過中にびらんの出現・消褪がみられた．そのほかに隆起の集積したポリポイド型が1例あった．自験例には乏しいが，MPSとの関連で重要なcolitis cystica profunda（CCP）3例の内視鏡像を呈示してその特徴につき述べた．また，MPS，CCPと鑑別を要する疾患についても述べた．

　Eleven cases of mucosal. prolapse syndrome (MPS) were studied endoscopically. MPS was prevalent among young females (7:4) with complaints of bloody discharge and/or abnormal stool habits. Endoscopically this syndrome was divided into two; ulcer state and nonulcer or preulcer state. The lesion was shallow, flat, and well demarcated. Occasionally the base appeared pinkish brown through the thin slough. The surrounding mucosa was raised, heaped-up or flat.

　Lesions without ulcer were erythematous with slightly raised mucosa and/or polypoid mucosa, or velvety pinkish mucosa. Non-ulcerated lesions sometimes had erosion.

　Colitis cystica profunda (CCP) is a variety of MPS. Endoscopically it resembles ulcerated cancer, sub-mucosal tumor or whitish elevations. Some important points concerning differential diagnosis of MPS and CCP were demonstrated.