Papagrigoriadis S, Rennie J A
Academic Department of Surgery, King's College Hospital, London, UK.
Postgrad Med J. 1998 Mar;74(869):168-9. doi: 10.1136/pgmj.74.869.168.
Rectal strictures are uncommon in young patients without a history of malignancy, inflammatory bowel disease or previous surgery. Lymphogranuloma venereum of the rectum has been described as a rare cause of rectal strictures in the western world, mainly in homosexual men and in blacks. It presents with nonspecific symptoms, rectal ulcer, proctitis, anal fissures, abscesses and rectal strictures. Clinical and endoscopic findings as well as histology resemble Crohn's disease, which may be misdiagnosed. Serology is often positive for Chlamydia trachomatis but negative serology is not uncommon. We present two young black women who suffered from chronic diarrhoea, abdominal pain and weight loss. There was no previous history and investigations showed in both cases a long rectal stricture. Serology was positive in one patient. They were treated with erythromycin and azithromycin and they both underwent an anterior resection of the rectum. Postoperative histology confirmed the presence of lymphogranuloma venereum of the rectum. We conclude that rectal lymphogranuloma venereum is a rare cause of rectal strictures but surgeons should be aware of its existence and include it in the differential diagnosis of unexplained strictures in high-risk patients.
直肠狭窄在没有恶性肿瘤、炎症性肠病或既往手术史的年轻患者中并不常见。直肠淋巴肉芽肿性炎在西方世界被描述为直肠狭窄的罕见原因，主要见于同性恋男性和黑人。其表现为非特异性症状、直肠溃疡、直肠炎、肛裂、脓肿和直肠狭窄。临床和内镜检查结果以及组织学表现与克罗恩病相似，可能会被误诊。血清学检查沙眼衣原体通常呈阳性，但血清学阴性也并不少见。我们报告了两名年轻黑人女性，她们患有慢性腹泻、腹痛和体重减轻。既往无相关病史，检查发现两例均有长段直肠狭窄。其中一名患者血清学呈阳性。她们接受了红霉素和阿奇霉素治疗，并均接受了直肠前切除术。术后组织学检查证实存在直肠淋巴肉芽肿性炎。我们得出结论，直肠淋巴肉芽肿性炎是直肠狭窄的罕见原因，但外科医生应意识到其存在，并将其纳入高危患者不明原因狭窄的鉴别诊断中。
