内視鏡像との対比よりみた非偽膜型合成ペニシリン起因性大腸炎のX線像

Radiographic and Endoscopic Findings in Penicillin-associated Non-pseudomembranous Colitis

　近年，化学療法の普及に伴って，薬剤性大腸炎が注目を浴びている．欧米では，かなり以前よりclindamycin，lincomycinによる偽膜性大腸炎がよく知られている．一方，本邦では比較的使用頻度の高い合成ペニシリンによる“出血性大腸炎”すなわち非偽膜型大腸炎の報告が多い．本症の臨床像，特に内視鏡像については既に詳細に報告されているが，X線像についてのまとまった報告はほとんどみられない．最近，著者らは合成ペニシリンに起因した非偽膜型大腸炎8例を経験し，そのX線像を内視鏡像と対比しながら経時的に分析したので，その成績を報告する．

　Eight patients with penicillin-associated non-pseudomembranous colitis were studied radiographically and endoscopically on changes with the passage of time. The results were as follows:

　1) In six patients, initial barium enema study performed within six days after the onset revealed abnormal findings such as narrowing, disappearance of haustration, disappearance of fine network pattern, multiple small barium flecks, transverse ridging, thumb printing and saw-tooth irregularity. In the remaining two patients, in whom the lesion was located within the rectum and/or sigmoid colon, there was no abnormality on radiography.

　2) In seven patients, initial colonofiberscopy performed six days after the onset revealed reddish-edematous mucosa with hemorrhage. In the remaining one, initial endoscopy performed ten days after the onset showed linear redness without hemorrhage.

　3) The lesions healed 10 to 38 days after the onset radiographically, and 15 to 63 days endoscopically.

　4) The lesions were distributed discontinuously in five of eight patients. The degree of lesion was relatively mild in the rectum, while it tended to be severe in the right-sided colon.