十二指腸に興味あるX線所見を呈した糞線虫症の2例

Strongyloidosis Showing Interesting X-ray Findings in the Duodenum, Report of Two Cases

要旨　第1例は28歳の男性で，嘔気，食欲不振，体重減少を主訴として来院．糞便，十二指腸液より糞線虫幼虫を検出．治療前の経口小腸X線検査では十二指腸は著明に拡張し，下行脚内側辺縁は不整で，その対側辺縁に数個の彎入を認めた．低緊張性十二指腸造影像では下行脚に淡いバリウム斑と大小の顆粒状陰影を認めた．第2例は72歳の女性で，嘔気，食欲不振，下腹部痛を主訴として来院．既往歴として10年前に糞線虫症で入院加療．検便で糞線虫を証明した．治療前の経口小腸X線検査では十二指腸下行脚は軽度拡張し，壁不整，Kerckringひだは消失し，小顆粒状陰影を認めた．急性期の十二指腸内視鏡像はKerckringひだは消失し，褐色調で易出血性の粘膜を認めた．そのときの生検で，十二指腸および胃粘膜から糞線虫の虫体および虫卵を証明した．

　〔Case 1〕 is a 28-year-old man. He was seen at this hospital with vomiting, anorexia and weight loss as his chief complaints. Larvae of Strongyloides stercoralis were detected in feces and duodenal juice. On barium meal study of the small intestine before initiation of the treatment, the duodenum was markedly enlarged, and the medial margin of the descending limb was irregular. Several indentations were noted in the contralateral medial margin. Hypotonic duodenography revealed light barium spots and granular densities large and small in the descending limb.

　〔Case 2〕 is a 72-year-old woman. She was seen at this hospital with vomiting, anorexia and lower abdominal pain as chief complaints. As for her past history, she had been hospitalized for the treatment of strongyloidosis ten years previously. Stool examination revealed strongyloidosis. On barium meal study of the small intestine before initiation of the treatment, the descending limb of the duodenum was seen to be slightly enlarged, the wall was irregular, Kerckring's folds were absent and small granular densities were noted. Endoscopic examination of the duodenum in the acute stage revealed the disappearance of Kerckring's folds and brown hemorrhagic folds. Biopsies taken then showed the body and egg of Strongyloides stercoralis in the mucosal folds of the stomach and duodenum.