Mallory-Weiss症候群のX線学的検討

Radiological Studies of Mallory-Weiss Syndrome

　Mallory-Weiss症候群は，1929年MalloryとWeissにより初めて報告された¹⁾．近年，上部消化管出血時の緊急ないし早期内視鏡検査の普及により，年々その報告例が増加している．最近では上部消化管出血の重要な出血源の1つとして常に念頭に置かねばならない疾患の1つとなってきた²⁾．

　本症の定義も時代と共に変わってきているが，筆者らは奥山ら³⁾の言う“嘔吐などにより腹腔内圧が急激に上昇し，噴門部近傍に裂創が発生し，これを出血源として顕出血を来した例”をMallory-Weiss症候群とするという定義が現時点では最も妥当であると考えている．

　Radiological studies were performed in 28 cases of Mallory-Weiss syndrome and the following results were obtained.

　1. Mallory-Weiss syndrome were diagnosed radiologically in 18 cases out of 28 (64.3%).

　2. Two types of laceration were recognized radiologically. One was a spindle-shaped niche showing gaping wounds, and the other was a linear barium collection showing linear laceration or a scar of the laceration. The author has designated this linear barium collection provisionally as skin joint appearante.

　3. The spindle-shaped niche changed into a skin joint appearance and cicatrized.

　4. The number of lacerations diagnosed radiologically matched the results of endoscopic diagnosis in 16 cases out of 18.

　5. As the Z-line has not been demonstrated radiologically in all cases yet, determination of the location of the laceration was difficult. However, when the mucosal pattern around the laceration is read in detail, or at the same time using the line XY index method as shown in Fig. 7, determination of the location of the laceration is to a certain extent possible.

　6. The most effective method for radiological diagnosis of Mallory-Weiss syndrome is to take a double contrast radiograph with a large amount of the negative contrast medium in the half-standing right lateral position when the cardiac orifice is open.

　7. The observed area around the cardia in the double contrast radiograph was the widest when taken in the right lateral position.

　8. When the position was changed from the right lateral position to the prone position, clockwise rotation of the cardia was observed.