直腸肛門部病変と胃腸病変

Anorectal Lesions and Gastrointestinal Diseases

　胃腸病変とこれに伴う直腸肛門部病変の関連性をよく理解しておくことは，胃腸病変の治療，診断に重要である．またその場合の直腸肛門部病変の治療をどうするかもゆるがせにできない問題である．

　ここではとくに最近問題になっているクローン病，潰瘍性大腸炎を中心とした胃腸病変と，さまざまな直腸肛門部病変すなわち肛門部の炎症，感染，狭窄，痔核などとの関連を自験例によって検討した．

　Anorectal lesions associated with gastrointestinal diseases (Crohn's disease, ulcerative colitis and others) were studied. The incidence, clinical course, characteristic findings and treatment of these anorectal lesions are discussed.

　We have treated seven cases of Crohn's disease in the recent four years. Five of them were accompanied with anal fistulas or perianal abscesses. Moreover, rectal strictures were recognized in two of the five cases. These anorectal lesions were not different from other common fistulas or abscesses. Multiple undermined anal fissures and grass anal ulceration were not observed in our cases. Gastrointestinal symptoms in our cases of Crohn's disease were often recognized several years after the occurrence of anorectal lesions. Anorectal lesions in Crohn's disease should be treated according to the local changes and the conditions of the gastrointestinal lesions.

　Of 73 cases of ulcerative colitis diagnosed and treated in these four years, seven (9.6%) were accompanied with such complication as perianal abscesses, and rectal stricture. Perianal abscesses most often occurred in the active stage of total colitis. Fistulas and abscesses in ulcerative colitis are often best treated by simple incision and drainage because of occasionally untoward effect of aggressive operation.