幽門部輪状狭窄を呈した早期胃癌の1例

A Case of Early Cancer of the Stomach Showing Ring-shaped Stenosis

症　例

　患　者：60歳　女性

　主　訴：腹部膨満感

　既往歴・家族歴：特記すべきことなし

　現病歴：約10カ月前に心窩部痛を認め，某医にて胃潰瘍と診断され，約1カ月間の投薬で症状は軽快した．約1カ月前より軽度の腹部膨満感を訴えて来院し，精査のため入院した．

　Approximately ten months before, a 60―year-old female was diagnosed as having gastric ulcer by a certain practitioner, and her condition improved with medical prescription. About a month before, she became aware of abdominal fullness and subsequently visited the hospital. Roentgenogram of the stomach showed abnormal findings in the body as well as in the antrum. In the body, converging folds in two sections were seen but niche was not observed. Malignant views of the folds and mucosa were not seen, and consequently it was diagnosed as multiple ulcer scars. Ring-shaped stenosis in the antrum, widening of the gastric angle, irregularity of lesser curvature contour were seen. It was difficult to clearly project the changes in the supine double contrast examination, but together with the use of compression in the prone double contrast examination, light irregularly shaped barium fleck was confirmed and diagnosed as Ⅱc. During this process, it was not easy to diagnose it as Ⅱc. Particularly, due to the confirmation of the presence of ring-shaped stenosis, linear ulcer was suspected. But, detailed interpretation of the roentgenograms confuted this. Endoscopic examination ended unsatisfactorily due to stenosis. An operation was conducted and it was diagnosed as Adenoca. Tubulare with depth of infiltration sm (of the antrum) and benign multiple ulcer scar (of the body). Distinct fibrosis in the submucosa, centered in the cancer lesion, was confirmed and found to be the cause of ring-shaped stenosis. But, strong ring-shaped stenoses were shown through roentgenograms by repeated erosion caused by cancer.