| Theme | Diseases of Alimentary Tract in Maintenance Dialysis Patients | |
|---|---|---|
| Title | Proctitis and anorectal disorders in patients undergoing maintenance hemodialysis | |
| Publish Date | 2006/07 | |
| 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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