放射線性下顎骨壊死の悪化による長期臥床に関連した反復性の急性出血性直腸潰瘍の1例

• Published in: 日本口腔外科学会雑誌 Vol. 63; no. 9; pp. 455 - 460
• Main Authors: 山本, 直典, 金崎, 朋彦, 松宮, 由香, 今井, 智章, 中澤, 光博, 岸本, 聡子
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.09.2017
• Subjects: 低栄養; 急性出血性直腸潰瘍; 放射線性骨壊死; 経腸栄養; 臥床状態
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.63.455

We report a case of recurrent acute hemorrhagic rectal ulcer (AHRU) associated with prolonged bedridden condition due to worsening osteoradionecrosis of the jaw (ORNJ). An 83-year-old woman who had previously received chemoradiotherapy for oropharyngeal cancer was referred to our hospital to treat a perimandibular abscess due to ORNJ. The patient also had a medical history of brain infarction and bilateral femoral fractures.　The abscess was controlled by pus drainage, debridement, and administration of antibiotics. On the 3rd hospital day, hematochezia abruptly occurred, colonoscopy revealed AHRU, and endoscopic hemostasis was performed. Then, rebleeding developed because of bedridden condition and worsening nutritional disorder. Nutritional support was continuously provided by a combination of intravenous and enteral nutrition, leading to improvement of undernutrition. The patient eventually underwent hemimandibulectomy without reconstruction.　Elderly patients with atherosclerosis-related comorbidities are at risk for AHRU when bedridden because of their vulnerability to rectal ischemia. Bedridden patients with severe oral diseases such as progressive oral cancer and ORNJ also have a potential risk of AHRU.