成人の胃重複症の1治験例

Duplication of the Stomach: Report of a case in an adult

　Ladd ＆ Gross⁸⁾の提唱以来，消化管重複症の報告は急速に増加し，いくつかの総説や統計的観察がなされており，従来考えられていたほど稀なものではなくなってきた．Gross⁵⁾は22年間での68例の症例を集計し，Sieber¹⁴⁾は21年間に25例を取り扱っているが，そのうち胃重複症はそれぞれ2例と3例である．本邦でも消化管重複症全体については多くの集計があり^31)～33)，その後の報告を加えると約150例であるが，最近に至って従来きわめて稀とされていた食道³⁴⁾や胃²⁸⁾の重複症についてもそれぞれの集計がなされており，消化管重複症も部位別の考察がなされるようになってきた．しかし胃重複症の報告は本邦ではまだ少なく，石田³²⁾は5例，池田³³⁾は7例を文献的に集めているにすぎない．著者もすでに3例の消化管重複症の経験を発表しているが³⁶⁾，そのうちのきわめて稀な成人の胃重複症について報告し若干の文献的考察を加えてみた．

　Duplications of the alimentary tract have been reported in about 150 cases in our country, while duplication of the stomach was found in only 7 cases in the Japanese literature (Ikeda, 1970).

　Report of a case

　A 47-year-old female visited our hospital because of recurrent epigastric pain. An upper G-Ⅰ series revealed an abnormal stream of barium starting from the third portion of the duodenum and running along the greater curvature of the stomach up to the level of the fundus.

　At operation on August 8, 1974, she was noted to have a large duplication of the stomach along the greater curvature from the antrum to the fundus with an orifice at its distal end measuring 2.0 cm in diameter and communicating with the horizontal part of the duodenum. The duplicated portion of the stomach was resected without sacrificing the original portion.

　The specimen measured 33 cm in length and 18 cm in the greatest diameter, and its inner surface was lined by gastric mucosa with multiple ulcers in the distal portion.

　Histologic examination showed multiple ulcers (Ul Ⅱ-Ⅳ) and a focal area with heterotopic submucosal glands. The patient's postoperative course was un-eventful.

　The pathology, clinical aspects and treatment of the duplicated stomach in the literature including the reports of 15 Japanese cases are discussed.