NSAIDs坐薬による直腸潰瘍の2例

Rectal Ulcer due to Diclofenac Suppositorium, Report of Two Cases

要旨　NSAIDs坐薬による直腸潰瘍の2例を経験した．〔症例1〕は坐薬使用後9日目に少量の下血で発症し，直腸の中部下部に出血性びらん・表層性の不整形潰瘍が多発するAGML様の病変を認めた．〔症例2〕は坐薬開始後，次第に下痢を生じ，約7か月の間に貧血が進行し便潜血テストも陽性のため内視鏡が施行され直腸に狭窄を伴う慢性潰瘍が認められた．NSAIDs坐薬起因性の直腸潰瘍に関する報告はまれであるが，実際は内視鏡が施行されず診断されていない症例も多いと想定される．〔症例2〕の経験からNSAIDs坐薬使用の際はその後も注意深く経過観察し，下血がなくとも下痢や貧血の進行を認めた場合は迅速な直腸の内視鏡検査が必要と考えられた．

　We experienced two cases of rectal lesions induced by NSAIDs suppository. In 〔Case 1〕, a little melena started on the 9th day after the use of the suppository, and a lesion with multiple occurrence of hemorrhagic erosion and superficial ulcers of irregular shapes resembling AGML (acute gastric mucosal lesion) was found in the middle and lower rectum. In 〔Case 2〕, the suppository gradually caused diarrhea, and anemia progressed in the period of about 7 months. As the fecal occult blood test was positive, endoscopy was performed and chronic ulcer accompanying stricture was found in the rectum. There are few reports on rectal lesions induced by NSAIDs suppository. It is assumed that endoscopy has not been performed for many cases and, therefore, diagnosis has not been established. Based on the experience in 〔Case 2〕, careful course observation seemed to be needed for the cases in which NSAIDs suppository was used as well as endoscopy if diarrhea or advanced anemia was detected even though melena was absent.