臨牀消化器内科 Vol.26 No.12(4-2)


特集名 内視鏡で遭遇する大腸隆起型および表面型病変を見直す
題名 その他のポリープ (2) 粘膜脱症候群
発刊年月 2011年 11月
著者 赤松 泰次 長野県立病院機構須坂病院内視鏡センター
著者 下平 和久 長野県立病院機構須坂病院内科
【 要旨 】 粘膜脱症候群は,腸管の逸脱によって粘膜が慢性的な機械的刺激を受けることが原因である.好発部位は下部直腸前壁で,直腸粘膜脱症候群と呼ばれるが,憩室が多発しているS状結腸,人工肛門の口側腸管,手術後の腸管吻合部近傍などにも認める場合がある.内視鏡所見は隆起型,潰瘍型,混合型に分類される.隆起型はcap polyposis,潰瘍型は放射線性直腸潰瘍,急性出血性直腸潰瘍,大腸癌などとの鑑別が重要である.診断は発生部位と内視鏡所見に加えて,組織学的に線維筋症の所見を認めれば確定診断できる.治療は,いきみなどの排便習慣を改善させることが大切で,直腸粘膜が機械的刺激をできるだけ受けないように指導する.
Theme Reappraisal of Colorectal Protruded and Flat Lesions Which are Encountered During Endoscopy
Title Mucosal Prolapse Syndrome
Author Taiji Akamatsu Endoscopy Center, Nagano Prefectural Hospital Organization
Author Kazuhisa Shimodaira Internal Medicine, Suzaka Hospital, Nagano Prefectural Hospital Organization
[ Summary ] Mucosal prolapse syndrome (MPS) is thought to occur due to chronic mechanical stimulation due to prolapse of the intestine. MPS is observed not only on the anterior wall of the rectum below the peritoneal reflection, but also on the sigmoid colon with multiple diverticles, at sites of the stoma for colostomies, and at sites of anastomoses after colectomies. Patients with rectal MPS usually exhibit abnormal evacuation habits such as straining during defecation, and have polypoid lesions and/or ulcerations on the anterior wall of the lower rectum. Endoscopic findings of rectal MPS can be divided into three types;polypoid type, ulcerative type, and mixed type. Polypoid type rectal MPS should be distinguished from cap polyposis. On the other hand, ulcerative type rectal MPS is different from rectal ulcerations due to radiation, acute hemorrhagic rectal ulcer, and rectal cancer. Characteristic histological findings may indicate fibromusculosis. Avoidance of straining during defecation is important for rectal MPS treatment.
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