急性出血性直腸潰瘍

Acute Hemorrhagic Rectal Ulcer with Special Reference to Its Clinical Findings

要旨　急性出血性直腸潰瘍13例について，臨床像と内視鏡の特徴について述べた．急性出血性直腸潰瘍は重症基礎疾患を有する高齢者に，突然無痛性の新鮮下血で発症する急性の直腸潰瘍である．基礎疾患としては脳血管障害8例（脱水症，肺炎合併各1例）大腿骨頸部骨折に肺炎合併2例，心不全に肺炎合併1例，血液疾患に肺炎合併1例，糖尿病性ケトアシドーシス1例の13例で脳血管障害に合併することが多く，基礎疾患に肺炎を合併した重症例が4例あった．原因は脳血管障害および重症基礎疾患に起因するストレス潰瘍説が有力と考えられた．内視鏡所見の特徴は歯状線直上の下部直腸に限局する浅い不整形，地図状ないし帯状の横軸に長い潰瘍で管腔の1/3周ないし全周に達する点にある．治療は全身状態と関係するが，止血さえ得られると潰瘍の経過は良好である，最近，血管露出例の2例に対し，アルコール止血を行ったが著効を示した．

　We presented the clinical and endoscopic characteristics of thirteen cases of acute hemorrhagic rectal ulcer. The underlying disease was cerebrovascular accident in eight cases (one with pneumonia and one with dehydration), femoral neck fracture with pneumonia in two cases, congestive heart failure with pneumonia in one case and hematologic disorder with pneumonia in the other. Acute hemorrhagic rectal ulcer often develops in patients with cerebrovascular accident and in patients with serious illness complicated by pneumonia (five cases in our series). We suspect the stress from either CVA or serious illness to be the pathogenesis of the ulcer.

　The characteristic endoscopic findings are irregular, geographical or circumferential shallow ulcer just above the dentate line in the lower rectum occupying from one third to the whole circumference of the lumen.

　Its prognosis depends on its underlying illness, but the clinical course of the ulcer itself is good if hemostasis is established. Alcohol hemostasis was very effective in two cases.