Analysis of Urgent Colonoscopy for Lower Gastrointestinal Tract Symptoms | 下部消化管症状に対する緊急大腸内視鏡の検討

原著

Analysis of Urgent Colonoscopy for Lower Gastrointestinal Tract Symptoms

^*Department of Gastroenterology, Japanese Red Cross Sendai Hospital
^**Department of Gastroenterology, Iwate Prefectural Central Hospital

Shinya OOMORI^* and Takao FUJIWARA^**

下部消化管症状に対する緊急大腸内視鏡の検討

^*仙台赤十字病院　消化器内科
^**岩手県立中央病院　消化器センター内科

大森　信弥^*　　藤原　隆雄^**

Abstract

Background and Aim : Urgent colonoscopy is usually performed in routine medical practice. However, several states of its clinical features are clearly unknown. We aimed to investigate the urgent colonoscopy for lower gastrointestinal tract symptoms and to elucidate its significance.
Methods : The total subjects were 379 patients, who were performed colonoscopy within 24 hours after the appearance of lower abdominal symptoms mainly. As to them, we investigated the following points: clinical symptoms, observed segments, the diagnosis, therapeutic treatments and the clinical features of the aged patients.
Results : The most frequent clinical symptom was hematochezia. The most frequent segment of the observation was sigmoid colon (50.1%). The disease most frequently found by urgent colonoscopy was postpolypectomy bleeding. Therapeutic endoscopic procedure was performed in 75 cases (19.8%). Endoscopic hemostasis was performed in 54 cases and urgent colonoscopy as therapeutic treatments in intestinal obstructive diseases was performed in 21 cases. Urgent colonoscopy with therapies was chiefly performed for patients with postpolypectomy bleeding, volvulus of the colon, and acute hemorrhagic rectal ulcer. The frequencies of postpolypectomy bleeding, nonspecific colitis and ulcerative colitis were significantly lower, and the frequencies of acute hemorrhagic rectal ulcer and volvulus of the colon were significantly higher in aged patients. With respect to the observed area, there was no significant difference of frequencies between the aged patients and not aged patients.
Conclusions : Urgent colonoscopy was useful for earlier diagnosis and treatments, and seemed to be important to speculate the individual pathogenesis, even if accurate endoscopic diagnosis was not perfectly gained.
要旨: 下部消化管症状に対して施行された大腸緊急内視鏡検査の状況を分析し，その意義を検討した。下部消化管症状の検索のために，発症後24時間以内に予定外で大腸内視鏡検査を施行した延べ379例を対象とし，臨床症状，観察範囲，診断，治療方法，高齢者における臨床像について検討した。最も多かった臨床症状は血便であり，全体の半数がS状結腸までの挿入観察であった。疾病としてはポリペクトミー後出血が最頻であった。治療内視鏡は，ポリペクトミー後出血，大腸軸捻転，急性出血性直腸潰瘍などの全体の約20%の症例に施行された。高齢者では，大腸軸捻転と急性出血性直腸潰瘍が非高齢者に比べ有意に高頻度であった。年齢による挿入観察範囲に有意差を認めなかった。下部消化管症状に対し行われる緊急内視鏡検査は，早期の診断や治療に役立つと共に，診断に至らないまでも個々の症例の病態を推測するうえで，重要な情報を与えうるものと考えられた。

Key words: urgent colonoscopy, lower gastrointestinal tract