上十二指腸角に認められたDieulafoy様潰瘍の1例

Dieulafoy's Ulcer of the Duodenum, Report of a Case

要旨　患者は37歳，男性．主訴は下血．側視鏡による上部消化管緊急内視鏡検査で，上十二指腸角に，周囲に潰瘍形成を伴わない径約1mmの露出血管を認め，十二指腸Dieulafoy様潰瘍と診断し，高張ナトリウム・エピネフリン液および純エタノール局注により止血した．十二指腸における本症はわが国では自験例を含めて15例の報告があるのみであり，更に球部を除く報告は自験例を含めて8例にすぎないため，若干の文献的考察を加え報告した．

　We encountered a case of Dieulafoy's ulcer (exulceratio simplex) of the duodenum. Endoscopic local injection of HSE (hypertonic angle saline epinephrin) solution and ETH (ethanol) was performed.

　A 37-year-old man was admitted to our hospital with hematemesis. Emergency endoscopy perfomed by sideview endscopy revealed arterial bleeding from an exposed vessel (about 1 mm) on the mucosa of the superior duodenal angle without any definite ulcer. Local injection of HSE solution and ETH was performed and satisfactory hemostasis was achieved.

　To our knowledge, 14 cases with Dieulafoy's ulcer (exulceratio simplex) of the duodenum have been reported in Japan. Furthermore, cases in which Dieulafoy's ulcer exists on the anal side of the bulbus numbered only eight (including our case), and in four patients (including our case) hemostasis was achieved by endoscopic local injection of HSE solution and ETH. Out of seven cases in the bulbus, ulcer was found by endoscopy eight patients, and hemostasis was achieved by local injection in six of them.