血清蛋白漏出を伴った胃巨大皺襞症（メネトリエ病）の1例

A Case of Giant Rugae of the Stomach with Protein-loss (Ménétrier's Disease)

　胃粘膜の巨大皺襞を示す疾患には肥厚性胃炎，悪性リンパ腫，スキルスなどがあるが，私共は蛋白漏出による低蛋白血症を伴い，X線および内視鏡的に典型的な巨大皺襞に加え腫瘤様外観を呈した肥厚性胃炎(メネトリエ病)の1例を経験したので報告する．

　症　例

　患　者：西○兼○　35歳　男子

　主　訴：下肢の浮腫

　現病歴：1977年6月頃より両下肢に浮腫が出現し，初期には朝になれば消失していたが，やがて1日中みられるようになった．食欲は良好で嘔気・嘔吐なく，下痢もみられなかった．近医受診し，血液検査，胃X線検査などを受け，低蛋白血症(総蛋白量4.3g/dl)および胃病変を指摘され，精査のため本院受診，9月1日入院となった．

　A 35-year-old man, who complained of bilateral pretibial edema, was admitted to our hospital. He had no remarkable family history nor past history. The laboratory data showed a marked hypoproteinemia (serum protein value was 4.4 g/dl), and the protein-loss into the alimentary tract was suggested by a protein-losing test utilizing RISA. X-ray photographs of the stomach showed extensive huge and tortuous folds at the greater curvature of the body and a large mass lesion measuring about 3 by 5 cm on the posterior wall of the angulus. The surface of both lesions was roughly granular. The distensibility of the gastric mucosa was well preserved.

　A gastrofiberscopic examination showed the same lesions as revealed by X-ray examination. It was concluded that the giant rugae at the greater curvature of the body were based on hypertrophic gastritis of the fundic mucosa, but strictly speaking, the mass lesion on the posterior wall of the angulus was not diagnosed correctly before surgery. There were three kinds of conceivable lesions about it: 1. It could be a part of a diffuse type of hypertrophic gastritis. 2. It could be a localized type of hypertrophic gastritis apart from a diffuse type. 3. A carcinoma might co-exist with hypertrophic gastritis in spite of the negative findings of the gastric biopsy under the endoscopic examination.

　The subtotal gastrectomy was performed because no improvement of the serum protein value was gained under the medical therapy, and the diagnosis of a diffuse type of primary hypertrophic gastritis was established. The lesion difficult to diagnose before surgery was only one part of it, and there was no evidence of malignancy. After surgery, he recovered his health, and about three weeks later the serum protein level was improved with its value of 6.0 g/dl.