自然寛解したと思われる巨大皺襞を呈した蛋白漏出性胃症の1例

Protein-losing Gastro-pathy with Spontaneous Remisson of Giant Fold: Report of a case

　われわれは低蛋白血症を伴う巨大皺襞症と診断した患者を経過観察中，巨大皺襞が消失し，低蛋白血症も改善した症例を経験したので報告する．

症例

　患　者：64歳　男性

　主　訴：両下腿部の浮腫

　家族歴・既往歴：ともに特記すべきことはなかった．

　現病歴：生来健康であったが，1973年12月20日頃，両下腿部の浮腫および腹部膨満感に気づき，某医を受診したところ，胃癌の疑いで1974年2月4日当科に入院した．この間，体重減少は認めなかった．

　入院時理学的所見：身長153.5cm，体重48.0kg，栄養状態中等度，眼瞼結膜に貧血は認めなかった．腹部はやや膨満し，軽度の波動を認め，両側下腿部に浮腫を認めた．

　A 64-year-old man was admitted to our clinic complaining of edema of both legs and occasional epigastric fullness of two months' duration. Laboratory examination revealed marked hypoproteinemia (3.4 g/dl), achlorhydria and excessive protein loss in gastric juice (1.7 g/dl). Upper GI series showed a filling defect and an enlarged tortuous fold in the greater curvature. Endoscopic examination of the stomach demonstrated giant rugae and a large amount of sticky whitish mucus hanging down from the fold. Mucosal biopsy revealed hyperplasia of the foveolar epithelium and elongation and cystic dilatation of the duct. There was no evidence of malignant changes. From these findings, a diagnosis of giant hypertrophic gastritis with marked hypoproteinemia was made.

　Surgery was refused by the patient and a conservative treatment with high protein diet, intravenous administration of plasma and blood transfusion was conducted. After improvement of hypoproteinemia he was dscharged from the hospital. Follow-up examination showed gradual subsidence of the edema of both legs in seven months. After ten months, the clinical examination revealed no abnormality. In this case a spontaneous remission of the disease was surmised.