5年余にわたって内視鏡観察ができた急性胃潰瘍から慢性胃潰瘍への移行例

A Case of Chronic Gastric Ulcer Transformed from Acute Gastric Ulcer

　急性胃潰瘍と慢性胃潰瘍の関連については臨床面，形態学また病態生理学の面から種々議論されているが，まだはっきりしたことがわかっていないのが実状である．

　この問題については本年（1979年）春の第65回日本消化器病学会総会において「胃の急性病変と慢性潰瘍」のシンポジウム¹⁾がもたれ，そこで著者らも述べているように，これから多くの症例を重ね，経験を積んだ上で初めて解決されるものと考えられる．

　It is debatable whether there is any relation between acute ancl chronic gastric ulcer. To discuss this problem, the symposium entitled “Acute Gastric Lesion and Chronic Ulcer” was held in the 65th Annual Meeting of the Japanese Society of Gastroenterology this spring (1979). Then, it was emphasized that this will not be solved until more cases of gastric ulcer which were useful for discussing this problem were studied.

　The following is a report of a case of gastric ulcer, considered a transformation from acute into chronic, which was presented at this symposium. A 31-year-old male patient, a saleman, chiefly complained of nausea and vomiting. His family history and past history are not particular.

　He is neurotic by nature but had no trouble of gastrointestinal tract until then.

　On September 25, 1970, he suddenly vomited bloody vomitus and then he noticed tarry stool. On September 29 when he was admitted, he complained of nausea and vomiting but no abdominal pain.

　On October 3, the first gastroscopy revealed irregular shallow ulcerations in the angulus with many small bleeding foci in the surroundings (Fig. 1-1, Fig. 2).

　During 70 days of admission, gastroscopy was done three times and the healing of ulcer was confirmed (Fig. 1-2, 3, 4). After leaving the hospital, the ulcer recurred or exacerbated five times in the same site as the first ulcer over five years (see Fig. 1). Acute abdominal symptoms such as severe abdominal pain, hematemesis or melena, did not always appear during these episodes.

　And finally on January 22, 1976, he noticed melena and then complained of upper abdominal pain, vomiting with nausea. On the 23rd he was admitted. Gastroscopy on the next day revealed a bleeding round ulcer in the gastric angle (Fig. 1-11). Though the bleeding from ulcer stopped after a while and the ulcer itself was becoming smaller and smaller, he was sent to a surgeon and underwent partial gastrectomy on March 19, 1976. (Fig. 1-12, Fig. 3).

　From the point of pathological findings, macroscopically, a depression 0.5×0.5cm in size was noticed on the angulus region, and many small erosions on the antrum. Histologically it was an ulcer scar and its surface was entirely covered by regenerated epithelium. Proper muscle layer was also disrupted and replaced by fibrous tissue.

　Clinically, the relation between acute gastric ulcer and chronic gastric ulcer may be of three possibilities: 1. there is no relation between these two types of ulcer. 2. acute gastric ulcer, after its healing, repeats recurrence in the same site. Gradually the ulcer becomes chronic and intractable. 3. some cases of acute ulcer directly transform into chronic ones.

　From the viewpoint of the endoscopist, the first view is most accepted because of healing in a short time and very rare recurrence of acute gastric ulcer. This case, however, repeated recurrence and became chronic ulcer, though its initial endoscopic picture was a typical acute gastric ulcer. Therefore, it is assumed that this case is an evidence for the second view mentioned above.