薬剤（ステロイド）による急性胃病変症例―経過観察中に拡大穿通を来した胃潰瘍の2例

Gastric Ulcer Enlarged and Penetrated in the Course of Follow-up, Report of Two Cases

　胃潰瘍の経過追求中蛋白同化ステロイド剤投与に由来して拡大穿通を来したと思われる2症例を呈示する．

症例

　〔症例1〕68歳　家婦

　約10カ月にわたる心窩部異和感を主訴として来院既往歴，家族歴に特記すべきものなし．胃X線検査にて胃角の潰瘍と十二指腸球部の変形を指適されて入院．入院時，瞼結膜やや蒼白で心窩部に軽度の圧痛がある他は年齢に担応した現症を示した．入院時諸検査では糞便潜血反応軽度陽性，中等度貧血，血沈充進，梅毒血清反応陽性のほか尿，血液血清化学定量，心電図に異常認めず．入院後の経過を表1に示した．

　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.