| 特集名 | 下血/血便をきたす腸疾患─non-IBDを中心に | |
|---|---|---|
| 題名 | ［各論］炎症性腸疾患と大腸癌以外の出血をきたす各種腸疾患の画像上の鑑別診断と治療 (10) 憩室症 | |
| 発刊年月 | 2010年 01月 | |
| 著者 | 花畑 憲洋 | 弘前大学大学院医学研究科消化器血液内科学講座 |
| 著者 | 五十嵐 崇徳 | 弘前大学大学院医学研究科消化器血液内科学講座 |
| 著者 | 荒木 康光 | 弘前大学大学院医学研究科消化器血液内科学講座 |
| 著者 | 吉村 徹郎 | 弘前大学大学院医学研究科消化器血液内科学講座 |
| 著者 | 福田 眞作 | 弘前大学大学院医学研究科消化器血液内科学講座 |
| 【 要旨 】 | 大腸憩室出血は高齢者の下部消化管出血のおもな原因の一つで，腹痛を伴わない突然の出血で発症する．大腸憩室出血の診断と治療は大腸内視鏡検査が有用である．しかし，近年では腹部造影CTの有用性が報告されている． 大腸憩室は筋層を欠く仮性憩室であるため，クリップ法など組織障害の少ない方法を選択するべきで，熱凝固法やエタノール局注法などによる止血は穿孔の危険性があり避けるべきである．内視鏡検査・治療が困難なときはIVRや外科手術も考慮する必要がある． |
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| Theme | Bloody stools in non -- IBD intestinal disorders | |
|---|---|---|
| Title | Bleeding from colonic diverticula | |
| Author | Norihiro Hanabata | Department of Gastroenterology and Hematology, Hirosaki University, Graduate School of Medicine |
| Author | Takasato Igarashi | Department of Gastroenterology and Hematology, Hirosaki University, Graduate School of Medicine |
| Author | Yasumitsu Araki | Department of Gastroenterology and Hematology, Hirosaki University, Graduate School of Medicine |
| Author | Tetsuro Yoshimura | Department of Gastroenterology and Hematology, Hirosaki University, Graduate School of Medicine |
| Author | Shinsaku Fukuda | Department of Gastroenterology and Hematology, Hirosaki University, Graduate School of Medicine |
| [ Summary ] | Bleeding from colonic diverticula is a major condition associated with lower gastrointestinal (GI) bleeding in elderly patients. The primary symptom related to this bleeding is lack of abdominal pain. Colonoscopy is usually performed initially and is useful when patients have hematochezia. Recently, helical computer tomography (CT) has been shown to be useful for the diagnosis of acute lower gastrointestinal tract bleeding. The colonic diverticula have no muscle layer. This means complications such as perforations can easily occur. In this disease, the use of heat coagulation or pure ethanol injections for hemostasis are contraindicated, because extreme tissue damage will result. Clipping should be performed in these cases, because it is the most safe and useful procedure. However, if this approach cannot be done or is unsuccessful, other therapeutic methods must be employed, such as interventional radiology or surgery. |
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