術後残存直腸の内視鏡追跡検査でdysplasiaが認められた1例

Dysplasia Associated with Ulcerative Colitis Detected by Surveillance Colonoscopy, Report of a Case

要旨　患者は41歳の女性で，1973年潰瘍性大腸炎の直腸炎型で発症し他医にて治療されていたが，1976年全大腸炎重症型に増悪し，1977年全結腸切除一回腸直腸吻合術を受けた．同年，残存直腸の再燃による粘血便を主訴に来院した．ステロイド坐薬による局所療法によって炎症は消失したが，cancer high risk群に属するため，1年に1度のsurveillance colonoscopyを施行していた．1986年，内視鏡検査で残存直腸に平盤状隆起病変が認められ，生検にてhigh grade dysplasiaと診断され直腸切除，回腸痩造設術が施行された．本例はsurveillance colonoscopyによってdysplasiaが発見された本邦第1例目であると考えられるので報告した．

　We present a case of a 41 year-old woman, a longs-tanding ulcerative colitis patient, with dysplasia which had detected by surveillance colonoscopy in the residual rectum. This is the first report in Japan, to the best of our knowledge.

　She began with proctitis in 1973. In spite of conservative treatment she suffered from total colitis in 1976. In 1977, she had ileo-proctostomy for severe total colitis. Because of her high risk for cancer, she has been followed up by surveillance colonoscopy since 1981. A slight flat elevation was found in the rectum in 1985, demonstrated clearly by the dyecontrast method, but the biopsies of the lesion showed dysplasia to be unlikely. In 1986, not only a plaquelike lesion but also granular mucosa surrounding that lesion were distinctly demonstrated by U-turned method in the rectum. Biopsies from the plaque-like lesion showed high grade dysplasia. Moreover, biopsies from the flat mucosa adjacent to the plaquelike lesion showed low grade dysplasia. On histological examination of the resected specimen, submucosal invasive carcinomas were found in two areas of the flat mucosa, as has been previously reported in western countries.

　It has been well recognized that colonoscopy with multiple biopsy specimens is a valuable surveillance technique. However, dye-contrast with indigocarmine and U-turned methods are also useful for detecting dysplasia, especially in cases where the lesions are only slightly elevated or granular. However, multiple biopsies are indispensable especially in the cancer high-risk cases. On endoscopic examination of longstanding ulcerative colitis, close attention should be paid in order to detect slight changes in the appearance of the mucosa.