胃に癌と迷入副膵が共存し，腸管にPneumatosis Cystoides Intestinalis

A Case of Pneumatosis Cystoides Intestinalis and Gastric Carcinoma Coexisting with Aberrant Pancreas

　Pneumatosis Cystoides Intestinalis（PCI）は大気成分に類似したガスを内容とする囊胞が腹腔内臓器，とりわけ腸管壁に多発性にみられるまれな疾患である．本症はDu Vernoy⁵⁾により剖検例ではじめて発見され，Mayer¹⁶⁾は豚小腸に見出しこれをPneumatosis Cystoides Intestinorumと呼んだ．人体症例に関する詳細な記載を行なったのはBang¹⁾が最初であり，つづいてHahn⁸⁾も生体でこれを発見し，豚のものとの形態学的類似性を認め，同じくPneumatosis Cystoides Intestinorumと命名した．

　内外を通じ，1967年までに400を越す報告があり，日本では三輪¹⁷⁾の剖検例による第1報以来1975年までに203例の報告がみられる．

　Pneumatosis cystoides intestinalis (PCI) was found in a 63 years old female who underwent a gastrectomy for marked pyloric stenosis with duodenal ulcer. Histological examination showed widespread adenocarcinoma of tubular type. Since tumor growth was noted mainly in the submucosal tissue coexisting with the aberrant pancreatic tissue, the tumor seemed most probably to be originated from the gastric mucosa.

　A part of the small intestine with numerous gasfilled cysts in the submucosa was also resected and submitted to a translucent and scanning electronmicroscopic study because of rare occurrence of such lesions and obscurity of their morphogenesis.

　It was indicated that the wall of most the gas-filled cysts was surrounded by fibrous connective tissue, and on the inner surface fibrocytic cell including some foreign body giant cells existed, and the endothelial lining cells were found to be obscure.

　In the present case, advanced pyloric stenosis and intestinal motility disturbing the lymph flow probably play an important role for the development of PCI.