胃全摘出術によって低蛋白血症の著明な改善をみたMenetrier病

A Case of Menetrier's Disease Treated with Total Gastrectorny

　著しい低蛋白血症と巨大皺襞を示したMenetrier病の1手術例を呈示し，合わせて巨大皺襞症の内視鏡診断について著者らの考え方を述べてみたい．

　A case of a 29 year-old man with Menetriefs disease is described.

　One year before admission, the patient had complaints of general fatigue and epigastric pain.

　Laboratory examinations revealed severe hypoproteinemia with a level of 5.9 g/dl and anemia with a hemoglobin level of 7.0 g/dl. examination (upper GI series) and gastroscopy showed markedly tortuous folds (giant rugae) on the greater curvature of the corpus and irregularly granulated mucosa at the lesser curvature of the upper corpus. On the contrary, in the pyloric gland area, an atrophic change of mucosa was observed.

　From these findings with hypoproteinemia, total gastrectorny was performed under a diagnosis of Menetrier's disease.

　Surgical specimen revealed the same giant rugae on the greater curvature and irregularly granulated mucosa on the corpus as observed in examination and gastroscopy.

　Histopathological findings of the giant rugae showed a thickened mucosal layer and a remarkably hyperplastic proliferation of the foveolar epithelium in the fundic gland area.

　The patient had uneventful postoperative course and the hypoproteinemia was improved with a level of 7.7g/dl 6 months, 7.8g/dl one year, and 7.5 g/dl 7 years, after operation.

　The diagnostic criteria of giant rugae have not always been clear. Therefore, in order to set up the endoscopic criteria of giant rugae, a relationship between intragastric pressure with a volume of the inflated air and distension of the gastric rugae has been investigated and good correlation has been found. From this result, a giant rugae should be still prominent and tortuous with the maximal inflation of the stomach with air (more than 1,700 ml).