長期間経過観察をした胃結核症の1例

Tuberculosis of the Stomach Followed Up for Four Years, Report of a Case

　胃結核症は，本邦報告例のほとんどが剖検または手術により診断されており，X線ならびに内視鏡診断学が進歩した現在でも，なお臨床診断がつけにくい疾患の1つである．

　内視鏡下生検の病理組織学的検討で本症を疑い化学療法を行いつつ，X線，内視鏡および生検にて経過観察をした胃結核症の経験に加え，本症の臨床，診断，治療上の問題点を主に本邦文献を中心に検討し報告する．

　Tuberculosis of the stomach in a 44-year-old woman, who has been followed up by serial x-ray and gastrofiberscopic examinations during four years, is described. The clinical, diagnostic and therapeutic problems in the gastric tuberculosis are reviewed especially in Japanese literature. One hundred and five cases of definite and probable gastric tuberculosis has been reported in Japan, and most of them are diagnosed histologically by either autopsy or resected materials. This case is the first one that is followed for long term whithout any operations.

　The patient complained of the loss of appetite because of severe epigastralgia.

　The red blood count was 349×10⁴/mm³; hemoglobin, 10.2 g/100 ml; hematocrit, 33%; total protein, 7.4 g/100 ml; albumin, 2.9/100 ml; stool examination, one positive for occult blood; erythrocyte sedimentation rate, 70 mm/h. X-ray films of the chest and barium enema studies were not remarkable.

　An upper gastrointestinal series revealed rigidity of the lesser curvature and irregular filling defect of the greater curvature of the lower portion of the stomach. which were very suggestive of an advanced cancer. Double contrast films in the prone position showed multiple, irregular-shaped and shallow ulcer niches, linked with one another on the anterior wall of the body of the stomach.

　Gastrofiberscopic examinations revealed multiple ulcers all over the lower portion of the stomach, which were irregular-shaped, shallow and white-coated, with the edematous mucosa around them.

　Histologically, the biopsy specimen from the stomach under gastrofiberscopy showed epithelioid cell granulomas with a few giant cells of Langhans type in the lamina propria, and the diagnosis was probable tuberculosis.

　Chemotherapy for tuberculosis was begun, and she was getting well. The follow-up studies consisted of mainly serial x-ray, gastrofiberscopic examinations and histological examinations of the biopsy sections from the stomach for assessment of therapeutic effect of chemotherapy.

　Serial upper gastrointestinal series and gastrofiberscopies revealed that the tuberculous ulcerations had healed up to scar formations and the gastric wall became smooth. The biopsy specimens from the stomach also revealed no evidence of tuberculous granulomas anywhere.