顆粒球吸着療法により安全に手術を施行できた潰瘍性大腸炎の1例

概要

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A 77-year-old female was admitted to another hospital complaining of abdominal pain and bloody diarrhea. She was diagnosed to have ulcerative colitis. Her condition did noto improve despite massive long-term steroid administration. As a result, she entered our hospital to undergo surgical treatment. IVH nutrition, which had been started by the previous hospital, was continued and after obtaining her informed consent, she was treated by granulocyte and monocyte apheresis (GCAP) in order to reduce the steroid dosage. The pain and diarrhea disappeared just after completing GCAP, but there was no remarkable change in her bowel habits. Steroid administration was gradually decreased without any aggravation of her clinical symptoms. A substantial bloody discharge and obvious abdominal oain appeared during a barium enema X-ray study performed shortly after the prednisolone dose was reduced to 20 mg/day. After prednisolone was reduced again to 15mg/day, a total colectomy and ileostomy were performed. Postoperatively, no infectious disease or delay in wound healing (typical adverse reactions to steroid treatment) occurred. She was discharged on the 34th postoperative day after an uneventful recovery. Our findings suggest that GCAP allowed for a tapering of the steroid dosage before surgically treating steroid resistant ulcerative colitis.
2003-10-25