難治性胃潰瘍の1例―局所要因から

Intractable Gastric Ulcer, Report of a Case: With Special Reference to Regional Factors

要旨　患者は64歳，男性．1970年，46歳時に検診で胃角部小彎に胃潰瘍を指摘された．よく服薬していたが，初回検査から17年10か月後の1987年2月にも同部は線状潰瘍となったまま，この間の長期のH₂受容体拮抗剤の服薬にもかかわらず治癒をみなかった．難治性の線状潰瘍の成り立ちに，潰瘍周囲の線維化と前後壁への潰瘍の再発・再燃が局所の要因として重要と考えられた．

　We reported here a 64-year-old male with an intractable gastric ulcer, in which we could observe sequential changes of a round ulcer resulting in an intractable linear ulcer during 17 years 10 months. Although he has been taking various anti-ulcer medicines including H₂ receptor-antagonist since the onset, he has never found a cure for the ulcer (scarring) at any time. At the onset a small round ulcer was observed in the lesser curvature of the gastric angle (Fig. 1). The ulcer remained unchanged during the following 9 years 9 months, and then another ulcer and 2 erosions appeared near the ulcer. The area including these 4 ulcerative lesions showed discoloration implying submucosal fibrosis (Fig. 2). Ten years and 6 months later a large polygonal ulcer was formed, and then the ulcer grew towards the anterior wall (Fig. 3, 4). Eleven years 4 months later it became a linear ulcer of 3 cm in length (Fig. 5). Eleven years 8 months later it grew towards the anterior and the posterior wall reaching 5 cms in length (Fig. 6). Since then, the linear ulcer has remained open in spite of the patient's taking H₂ receptor-antagonist for 6 years 4 months (Fig. 7). Intense fibrosis around an ulcer and recurrence in the anterior and posterior wall near the ulcer play important roles in the formation of intractable linear ulcer of the stomach.