ナイ ジカク ニ タイ スル リュウサン アルミニウム ・ タンニン サン チュウシャ エキ ( ALTA ) リョウホウ シコウ 5 カゲツゴ ニ ショウジ タ コウモン カン ・ チョクチョウ ネンマク ヘンセイ ノ 1 レイ : ALTA シコウ ゴ ノ ネンマク ヘンセイ

症例60歳女性,10年来の脱出性内痔核の治療として2014.2.12硫酸アルミニウムカリウム・タンニン酸注射液(Aluminium Potassium Sulfate Tannic Acid:以下ALTA)を使用した四段階注射痔核硬化療法を受けた.経過良好であったが,7月中旬よりの肛門痛・発熱にて入院,触診のみでボロボロ崩れ落ちてゆく5時方向を中心とした約1/4周を占める広範な肛門管・直腸粘膜変性壊死を認めデブリードマン施行.疼痛・発熱は持続したが,禁食,抗生物質・解熱剤の投与,2回の追加デブリードマンにて,変性壊死部位は脱落し潰瘍と変化し,一か月後軽快退院した.非常に稀な経過と考えられたため報告した.Recently, the number of the Aluminum Potassium Sulfate and Tannic Acid(ALTA)injections therapy for internal hemorrhoids have been increasing markedly in Japan because of its minimal invasive therapy, quick response and acceptable recurrence rate. However, there are some reports of adverse reactions and side effects after ALTA such as Fournier\u27s Gangrene, rectovaginal fistula and rectal ulcer. We experienced a case of anorectal mucosal degeneration and necrosis after five months ALTA injection for internal hemorrhoids. A 60 year-old female was treated with sclerosing therapy with ALTA injection for grade II～III internal hemorrhoids according to the Gligher classification. Although the patient was in good course in 5 months after therapy, she developed a high fever and anal pain. Antibiotics were administrated, but remission was not achieved. Three times debridements were performed under local and intravenous anesthesia with a diagnosis of anorectal mucosal degeneration and necrosis. After approximately a month admission in the hospital was necessary for the treatment of the anorectal ulcer after debridements, she has been free from fever, pain and hemorrhoids