急性出血性直腸潰瘍の1例

Acute Hemorrhagic Rectal Ulcer, Report of a Case

要旨　62歳の女性で前脊髄動脈症候群の治療中に大量の下血を繰り返したために，RI‐アンギオグラフィーおよび下腸間膜動脈造影を施行して出血部位を確認しえた出血性直腸潰瘍の1例を経験した．保存的治療で一応止血されたが，出血を繰り返す可能性があることと，大便失禁があることから直腸切断術ならびに永久的人工肛門造設術を施行した．切除標本では歯状線に接して全周性に帯状のUl-Ⅲの潰瘍がみられ，更に約4cm口側の右側前壁に粘膜集中像を伴う1.8×0.5cm大のUl-Ⅱの潰瘍がみられた．組織学的には前者の潰瘍底縁の一部に再生粘膜上皮がみられ，後者では単純性潰瘍の像がみられた．

　A 62 year-old woman had been treated for anterior spinal artery syndrome at the Oita Medical College Hospital. She had frequent massive anal bleeding which had caused her to fall into a state of shock, and had received blood transfusion along with other conservative treatment. We identified the location of the bleeding by RI-angiography and angiography of the inferior mesenteric artery. Miles' operation was performed for the reason that she had both anal bleeding and severe incontinence. Removed specimen showed two ulcers. One of them was a circumferential linear ulcer in the rectum near the dentate line which was histologically Ul-Ⅲ. Another one was a partially healing ulcer with converging folds at a position 6 cm above the dentate line and histologically Ul-Ⅱ.