| 特集名 | 維持透析患者の消化管疾患 | |
|---|---|---|
| 題名 | 維持透析患者の直腸炎・痔核 | |
| 発刊年月 | 2006年 07月 | |
| 著者 | 塚田 有紀子 | 沼津市立病院腎臓内科 |
| 著者 | 若林 良則 | 沼津市立病院腎臓内科 |
| 【 要旨 】 | 末期腎不全患者に発症する直腸炎は，その成立機序を明確にすることが困難な場合があるが，虚血性の因子と感染性の因子が関与しているものと思われる．われわれの経験した糖尿病を有する69歳の女性維持透析患者に発症した直腸炎は難治性であり，長期にわたる腸管安静 (21日間絶食後，54日間流動食) と抗生剤の45日間にわたる経静脈投与により，ようやく寛解を維持できた．骨盤部単純CTでみられた直腸壁の異常所見の消長は，直腸炎の病勢の推移と一致した．また，維持透析患者では便秘を伴うことが多く，痔核の原因の一つとなる．肛門周囲膿瘍などの肛門部の疾患が重大な結果を招くこともある． | |
| Theme | Diseases of Alimentary Tract in Maintenance Dialysis Patients | |
|---|---|---|
| Title | Proctitis and anorectal disorders in patients undergoing maintenance hemodialysis | |
| Author | Yukiko Tsukada | Department of Nephrology, Numazu City Hospital |
| Author | Yoshinori Wakabayashi | Department of Nephrology, Numazu City Hospital |
| [ Summary ] | Dialysis patients are at increased risk of developing a number of complications related to lower gastrointestinal lesions. The rectum is thought to be spared ischemic colitis because of its abundant collateral blood supply. The origin of proctitis in dialysis patients can be obscure, and the disease can be refractory. In one case of proctitis in a 69-year-old diabetic Japanese woman receiving chronic hemodialysis, it was necessary, in order to maintain her state of remission, to continue parenteral alimentation for 21 days, providing a liquid diet for the subsequent 54 days and administering antibiotics for 45 days. Computed tomography examination demonstrated circumferential thickening of the rectal walls, and was useful in estimating disease progression. The cause of the common occurrence of constipation in hemodialysis patients seems to be multifactorial. Chronic constipation may lead to various complications, such as hemorrhoids. Heparin may increase the bleeding risk with anorectal disorders. Chronic constipation should be avoided by prophylactic laxative administration. Anorectal disorders, such as perianal abscesses, possibly precipitate Fournier's gangrene. The mortality rate associated with Fournier's gangrene is high, and is even higher when complicated by perirectal disorders. |
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