ESDが貧血改善に有効であった多発隆起型直腸粘膜脱症候群の1例

The Multiple Elevated Type Rectal Mucosal Prolapse Syndrome in which Endoscopic Submucosal Dissection was Effective for Improvement of Anemia, Report of a Case

要旨●患者は20歳代，男性．排便時出血を主訴に前医を受診し，高度の貧血を認めた．大腸内視鏡検査で直腸に病変を認め，生検で診断がつかないため当院に紹介となった．大腸内視鏡検査では，直腸前壁の第2 Houston弁上，第1 Houston弁上，直腸下端に白苔で覆われた発赤調の隆起性病変を認めた．診断目的で小病変に対して内視鏡的粘膜切除術（EMR）を施行し，直腸粘膜脱症候群と診断した．保存的加療で貧血が改善しないため，3病変すべてに対して内視鏡的粘膜下層剝離術（ESD）を施行した．ESD 2年後には直腸下端以外の2病変の再発がみられた．排便指導と緩下剤により，ESD 5年後には第2 Houston弁上の発赤を伴う浅い潰瘍のみとなった．貧血の改善が得られたため，ESD治療は有用であったと考えられた．

　A 20's-year-old man presented to a local doctor with complaints of bleeding during defecation. The patient underwent colonoscopy for advanced anemia. Multiple protruding lesions were found in the rectum. The doctor did not make a diagnosis based on lesion biopsy and referred the patient to our hospital for detailed examination. Colonoscopy revealed large, red, elevated lesions with white mucus on the second Houston's valve, first Houston's valve, and bottom of the rectum. We performed endoscopic mucosal resection of the small elevated lesion for diagnosis. Based on the histological findings, we diagnosed the patient with rectal mucosal prolapse syndrome. Because there was no improvement in anemia, we performed ESD（endoscopic submucosal dissection）for the three large elevated lesions. There was a recurrence in two lesions on the second Houston's valve and first Houston's valve 2 years after ESD. There was a shallow ulcer with redness on the second Houston's valve due to defecation guidance and laxative administration 5 years after ESD. The patient's anemia improved. We demonstrated the efficacy of ESD for large lesions of mucosal prolapse syndrome.