胃壁膿瘍の1例

Gastric Wall Abscess, Report of a Case

要旨　患者は54歳，女性．主訴は心窩部痛．生来健康で，特に誘因なく心窩部痛が出現し，CRPが2.2mg/dl以外に血液検査上も異常を認めなかった．上部消化管内視鏡検査にて胃幽門部に強い粘膜集中を伴った粘膜下腫瘍様病変を認め，肛門側に憩室様陥凹部と口側の不整部に小孔を認めた．腫瘤口側の小孔にERCP用カニューラが挿入可能で，白色膿性物が流出し内視鏡的ドレナージを施行しえた．膿性物の細胞診では悪性細胞は認めず，多数の好中球を認め，培養ではStreptococcus属を認めた．各種画像所見も合わせ胃壁膿瘍と診断し，抗生物質を投与するも腫瘍が消失しないため手術を施行した．最終病理診断は胃壁膿瘍であり，前庭部の陥凹部は憩室型の重複胃であった．

　A 54-year-old female with the chief complaint of appetite loss visited our hospital for a close examination and treatment of a tumor in the antrum of the stomach. X-ray and endoscopic examination showed a submucosal tumor (SMT) -like change, which had a diverticulum-like deep hole on the anal side. This SMT-like lesion had a small pit with white pus discharge on its oral side. We were able to put the cannula for ERCP into the pit and performed endoscopic internal drainage. There were many neutrophils but no cancer cells in the pus. The pus culture grew Streptococcus species. Abdominal CT scan disclosed a hypodense mass with calcification at the greater curvature of the antrum and contrast enhanced CT demonstrated the thickening of the gastric wall with irregular enhancement. Endoscopic internal drainage and antibiotic therapy decreased the size of the tumor but it didn't disappear completely. Because of this we performed distal gastrectomy and lymph node dissection. A pathologic specimen showed that the lesion was a gastric wall abscess with phlegmonous change and the hole of its anal side was the diverticulum-typed overlap of the stomach.