抄録
Aluminum potassium sulfate and tannic acid (ALTA) is a sclerosing agent for hemorrhoids. Here we report two cases in which this agent was injected via colonscopy in place of hypertonic saline epinephrine to provide hemostasis in the lower rectum.
Case 1 : An 84-year-old female inpatient with chronic heart failure had hematochezia and acutely developed shock. Emergency colonoscopy was performed, and identified a Dieulafoy’s ulcer with active bleeding above the dentate line. ALTA (1 ml) was injected into the exposed vessel, instantly stopping the bleeding. The bleeding area was also sealed using argon plasma coagulation (APC) . Three days after treatment, swollen whitish mucosa without ulceration was observed at the treated site.
Case 2 : A 98-year-old man was admitted with a two-day history of hematochezia after undergoing a glycerol enema and rectal mucosal scraping. Colonoscopy identified a mucosal injury with heavy bleeding above the dentate line. ALTA was injected into the point of the gush and around the ulcerated region, and almost completely suppressed the bleeding. Colonoscopy three days later showed reduced ulcer size with surrounding swollen whitened mucosa, and one week after complete healing of the ulcer.
ALTA has a rapidly-acting astringent hemostatic effect on mucosa and a sclerotic effect due to non-bacterial inflammation with fibrosis. In addition, it has been reported that the risk of secondary ulcer by ALTA injection is between 0.45 and 4.6% in hemorrhoid treatment. Therefore, we considered that ALTA would be a suitable hemostatic agent to administer by colonoscopic injection in the lower rectum.
