18.急性出血性直腸潰瘍

Acute Hemorrhagic Rectal Ulcer

要旨　急性出血性直腸潰瘍は動脈硬化の要因を背景に血流低下の準備状態にある高齢者が，何らかの理由で寝たきり状態になることから，下部直腸の粘膜血流の減少を来し惹起される急性の虚血性粘膜障害と考えられている．原疾患が改善し，止血がなされれば本症の予後は良好とされており，止血が非常に重要である．ほとんどの場合は内視鏡的に止血可能であるが，不可能であれば経肛門的結紮術も考慮する．本症と診断した後は再出血と潰瘍の治癒促進のため，患者を仰臥位で放置せず適宜体位変換を行うことが重要である．

　Acute hemorrhagic rectal ulcer is regarded as an acute ischemic mucosal disorder that occurs in elderly patients who are suffering from incipient blood flow reduction due to arteriosclerotic factors. These patients are often bedridden, and this causes a decrease in mucosal blood flow in the lower rectum, which in turn triggers this pathology. If the underlying disease is improved and hemostasis can be achieved, the prognosis is likely to be good. Hemostasis is therefore extremely important. In most cases, bleeding can be arrested endoscopically, if not, transanal ligation is an alternative. After this disorder is diagnosed, it is important to prevent recurrent hemorrhage and to promote ulcer healing by encouraging the patient to make frequent postural changes, rather than staying in a supine position.