胃結腸痩，脾膿瘍を形成し，膿胸を併発した胃悪性リンパ腫の1例

Gastro-colic Fistula with Splenic Abscess and Thoracic Empyema Due to Malignant Lymphoma of the Stomach, Report of a Case

要旨　患者は80歳，男性．主訴は吐血，下血．1984年12月左膿胸のため入院1985年2月エコーにて脾膿瘍が指摘され，上部消化管造影で胃結腸痩が発見された．2月25日，胸腔内持続吸引ドレーンより便汁が排出されるようになったため開腹手術を施行した．胃上部大彎側は脾内側縁と，脾下縁は横行結腸と癒着し，その間に膿瘍が存在した．内容には便を混じ，膿瘍は左胸腔へ穿破していた．噴門側胃切除，脾摘，横行結腸部分切除を施行した．術後縫合不全はみられなかったが，呼吸不全のため第15病日死亡した．病理組織は，結腸浸潤，脾浸潤を来した胃悪性リンパ腫で，LSG分類ではdiffuse lymphoma large cell typeであった．

　An 80 year-old man was referred to our hospital with the complaints of dyspnea and chest pain. Treatment of thoracic empyema was performed with utbe thoracostomy. About two months later, he complained of abdominal pain. Echo examination revealed splenic abscess, and upper gastrointestinal series showed gastro-colic fistula due to malignant tumor in the left upper abdominal cavity (Fig. 1). Hematemesis and melena were observed and stool mass was recognized in the thoracic tube inhalt (Fig. 3).

　Emergency laparotomy was performed, and proximal gastrectomy, partial colectomy and splenectomy were carried out (Fig. 4).

　Pathologically, malignant lymphoma of the stomach’large cell type (Lymphoma-Leukemia-Study-Group) had infiltrated to the colon and spleen, and had caused splenic abscess and thoracic empyema (Figs. 5-8).

　Gastro-colic fistula due to malignant lymphoma of the stomach is very rare. In Japan gastro-colic fistula due to malignant lymphoma of the stomach has been reported only three times in medical literature. And it is supposed that this is the first description of complications such as splenic abscess and thoracic empyema.