異物による胃粘膜下炎症性腫瘤の1例

Foreign Body Granuloma of the Stomach, Report of a Case

要旨　患者は78歳，女性．主訴は心窩部痛．胃内視鏡検査で，前庭部に急性胃粘膜病変を認め，同時に，傍幽門後壁と体下部小彎後壁に，小さな粘膜下腫瘍（SMT）様所見を認めた．経過観察中に，このSMT様隆起が急速に著明に増大し，表面にびらんと潰瘍を形成した．初診より約10か月後に，胃部分切除術を施行した．切除標本では，前庭部から胃角の後壁に，3×7cmの弾性硬の腫瘤を認めた．割面では，固有筋層から漿膜下組織にかけて膿瘍を認め，中央部に異物が存在した．この異物は，1本の爪楊枝と判明した．誤嚥した爪楊枝が胃壁内に侵入し，それが原因となり，炎症性腫瘤を形成した極めてまれな1例を経験したので，若干の文献的考察を加え報告した．

　A 78-year-old female with the chief complaint of epigastralgia was found endoscopically to have acute gastric mucosal lesion in the antrum as well as a small submucosal tumor (SMT)-like change in the posterior wall of the parapylorus and the lesser curvature of the lower body. This SMT-like lesion grew rapidly and developed erosion and ulcer on the surface. Partial gastrectomy was carried out 10 months after the first visit.

　Examination of the resected specimen showed an elastic tumor measuring 3×7 cm involving the posterior wall of the antrum and angulus. Cut surface of the specimen exhibited an abscess in the propria muscularis and subserosal layers with a foreign body in the center. This foreign body proved to be a toothpick. It is speculated that an erroneously swallowed toothpick entered into the stomach wall leading to the formation of an inflammatory tumor.

　We thus experienced a very rare case and presented it here as well as literature review.