| 特集名 | IBDと合併症 | |
|---|---|---|
| 題名 | 腸管合併症 (4) 痔瘻，痔瘻癌 | |
| 発刊年月 | 2013年 05月 | |
| 著者 | 小金井 一隆 | 横浜市立市民病院外科 |
| 著者 | 辰巳 健志 | 横浜市立市民病院外科 |
| 著者 | 二木 了 | 横浜市立市民病院外科 |
| 著者 | 黒木 博介 | 横浜市立市民病院外科 |
| 著者 | 木村 英明 | 横浜市立大学附属市民総合医療センター炎症性腸疾患センター |
| 著者 | 杉田 昭 | 横浜市立市民病院外科 |
| 【 要旨 】 | クローン病には高い頻度で痔瘻をはじめとする肛門病変が合併する．痔瘻にはクローン病の直腸病変から生じた続発性難治性病変と，通常の痔瘻が偶発的に生じた通常型病変があり，鑑別を要する．注腸造影検査，内視鏡検査，MRIなどで痔瘻の拡がりと直腸肛門病変を診断する．治療にはクローン病の腸管病変と原発巣に対する治療に合わせ，抗生剤などの内科治療と必要に応じてseton法などの局所外科治療を行う．改善しない例や他の直腸肛門病変を伴う例には人工肛門造設術や直腸切断術が行われる．痔瘻癌合併例が増加しつつあるが，進行癌が多く，早期診断には痔瘻を合併した長期経過例では症状の変化に留意し，疑いのある症例では積極的な生検病理診断を行う必要がある． | |
| Theme | Complication of Inflammatory Bowel Disease | |
|---|---|---|
| Title | Perianal Fistula and Carcinoma Arising from Perianal Fistula Complicating with Inflammatory Bowel Disease | |
| Author | Kazutaka Koganei | Surgical Department, Yokohama City Municipal Hospital |
| Author | Kenji Tasumi | Surgical Department, Yokohama City Municipal Hospital |
| Author | Ryo Futatsuki | Surgical Department, Yokohama City Municipal Hospital |
| Author | Hirosuke Kuroki | Surgical Department, Yokohama City Municipal Hospital |
| Author | Hideaki Kimura | Inflammatory Disease Center, Yokohama City University Medical Center |
| Author | Akira Sugita | Surgical Department, Yokohama City Municipal Hospital |
| [ Summary ] | Perianal fistulas are frequent manifestation of Crohn's disease. There are two types of fistula, one arises from deep ulcers caused by Crohn's disease in the rectum or anal canal. The other type consists of incidental fistulas following crypt glandular infection. After collecting a detail history and conducting clinical examinations for anal lesions, colonoscopies or barium (Gastrografin®) enema studies, MRI, CT or other modalities are employed to detect the fistulous tracts or abscess and evaluate other anorectal lesions, such as anorectal stenosis or rectal fistulas. Medical treatment with antibiotics, immunomodulators, and antitumor necrosis factor α therapy, as well as local surgical treatments, such as non-cutting seton drainage, are performed. Treatment for both intestinal and anorectal Crohn's disease is also necessary to control perianal fistulas. Despite treatment with medications and local surgical treatment, some patients need diversionary stomas or proctectomies. A number of case reports have indicated that the number of the carcinomas arising from perianal fistulas is increasing in Japan. Care must be taken in treating Crohn's disease patients with longstanding perianal fistulas. Approximately ten percent of patients with ulcerative colitis patients have perianal fistulas, mostly caused by crypt glandular infections. |
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