毎日の浣腸で減薬が可能となり，巨大結腸，イレウス傾向の改善を見た1例

A Case with Successful Reduction of Medication Dose and Improvement of Mega Colon and Risk of Ileus Through Daily Enema

はじめに

　薬物治療は精神療法や行動療法同様，精神疾患の治療において治療の軸となる。精神科治療薬は単一の神経伝達系に作用するのではなく，さまざまな副作用を有する。可逆的な副作用もあれば不可逆的なものもあり，重症度も違う。その中で慢性的な便秘には日常的に遭遇し，イレウス，巨大結腸も散見される。

　巨大結腸症はX線造影で結腸の最大径が7cm以上のものをいう。以前羽生ら^3,4)が報告したが，長期入院患者に慢性の便秘が多く，下剤の投与量も多い。巨大結腸は一般に不可逆的と考えられているが，今回我々はイレウスを繰り返し，巨大結腸を呈してから10年が経過し体重減少が著しかった1症例に対し，毎日のGlycerine enema(以下GE)を試みたので報告する。

　A case is of a man of 35 years old, who developed schizophrenia at 15 years old, and experienced repeated hospitalization. He transferred to our hospital at 20 years of age. He has suffered from ileus and mega colon for 10 years. As a result, his body weight had decreased to 42.2kg. We performed glycerin enema once a day for prevention of ileus and depression of mega colon. About 2 months later, we were able to start to decrease types and dosages of antipsychotic drugs for half a year. We were also able to substitute paste food by a solid food gradually from the tenth month. There was no episode of ileus afterwards and psychotic symptoms did not worsen during one year. His body height was 162.5cm and his body weight increased to 56.0kg from 42.2kg. His Body Mass Index (BMI) was improved to 21.2 from 16.0. Conclusion：we performed glycerin enema every day, and the antipsychotic drug was able to be reduced. The possibility is suggested that glycerin enema on a daily basis is useful for protection against ileus add mega colon.