大腸憩室疾患の病態・病理―大腸憩室疾患の病態─憩室の発生・憩室出血・憩室穿孔

Clinical Characteristics of Diverticulosis in the Large Intestine-Incidence, Diverticular Bleeding and Diverticular Perforation

要旨　1999年から3年間に行った注腸検査1,040例のうち大腸憩室は373例（35.9％）に認められた．大腸憩室は年齢とともに増加し，右側結腸では40歳代まで急激に増加したが，左側結腸では年齢とともに次第に増加し，右側結腸とほぼ同率になった．大腸出血性疾患557例のうち大腸憩室出血は55例で，出血部位は左側結腸40例，活動性出血を認めた例は7例，治療は外科手術1例，塞栓術1例，内視鏡的止血術5例であった．便秘症は56.4％，内服薬はLDAを含む抗血栓薬が43.6％，LDAを服用した者が27.3％，NSAIDsが25.5％であった．大腸憩室炎に伴う穿孔に対して治療を行った14例はS状結腸に最も多く発生し，内服薬はNSAIDs 5例，便秘薬5例，LDA 2例であった．

　In 1040 barium enema examinations during 3years from 1999, 373cases（35.9％）were diagnosed as colonic diverticulosis. The number of cases with colonic diverticulosis increased with aging. While cases of right colonic diverticulosis increased rapidly in the forties, cases of left colonic diverticulosis increased with aging. The prevalence of left colonic diverticulosis in elderly patients was to the same extent as that in the right colon. In 557cases of hemorrhagic bowel diseases, 55 diverticular bleeding cases were included. Of the diverticular bleeding cases, 40cases were recognized as bleeding in the left colon, 7cases showed active bleeding. In treatment of diverticular bleeding, surgical resection was performed in one case, embolization was performed in one case, and five cases were treated by endoscopic hemostasis. 56.7％of diverticular bleeding cases had constipation. 43.6％ of cases were taking antithrombotic drugs including low-dose aspirin（LDA）, 27.3％were taking LDA, and 25.5％were taking NSAIDs. 14 perforated diverticulitis cases were treated in our institution. The sigmoid colon was the commonest site in cases of perforated diverticulitis. Perforated diverticulitis patients took NSAIDs in 5cases, laxatives in 5 cases, and LDA in 2cases.