Gastric Ulcer Enlarged and Penetrated in the Course of Follow-up, Report of Two Cases Y. Sakai 1 , T. Shimizutani 1 , T. Nishikawa 1 , S. Nitanai 1 , N. Nagano 1 1Dept. of Internal Med., Tokyo Medical College pp.69-74
Published Date 1973/1/25
DOI https://doi.org/10.11477/mf.1403108346
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 Case 1: A 68-year-old housewife complaining of unpleasant epigastrial sensation of about 10 month's duration was admitted because roentgenogram revealed gastric ulcer. Shortly thereafter a medium-sized, almost round ulcer was found by gastrocamera on the lesser curvature of the angle slightly toward the antrum. Gastric juice showed high acid value. When examined 40 days later by x-ray after treatment with anti-ulcer agents, the ulcer was reduced in size. Gastrocamera disclosed a round callous ulcer with its margins swollen and reflecting light brightly. Gastric juice this time was of low acidity. Subjedtive symptoms disappeared. Re-examination by both x-ray and gastrocamera after one month's medical management revealed the ulcer enlarged. Anabolic steroids were added. Despite subsequent hematemesis and epigastrial pain steroids were continued. X-ray showed penetrated, enlarged ulcer, while gastrocamera brought out hemorrhagic ulcer. At first she did not agree to surgical correction, but as hematemsis persisted along with tarry stool, emergency operation was performed. It revealed penetrated and perforated ulcer, measuring 52 by 30 mms.

 Case 2: A housewife 49 years old was admitted because of epigastric pain lasting since one month before. Roentgenogram revealed a huge ulcer in the middle to lower corpus. Interpretation by gastrocamera was benign. Anti-ulcer agents were combined with anabolic steroids. X-ray and gastrocamera showed ulcer reduced in size. Loss of appetite and pain radiating to the back persisted, however. Gastric juice showed hyperchlorhydria. Re-examination done because of increasing nausea and anemia revealed enlarged ulcer. Surgical intervention disclosed penetrated, perforated ulcer, which measured 78 by 52 mms.

 What really lay at the base of penetration in both cases remains uncertain, but common to both was the use of anabolic steroids each lasting 2 and 1 month. Anabolic steroids are beneficial to the treatment of gastric ulcer in that they tissue-regenerating action by accelerating granulation, but, on the other hand, they are vagal stimulants. Careful selection and evaluation of them had been necessary that are potent enough to cope with stimulation of the vagus.

Copyright © 1973, Igaku-Shoin Ltd. All rights reserved.


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