胃結核の3例

GASTRIC TUBERCULOSIS REPORT OF THREE CASES

Ⅰ．はじめに

　レ線検査，内視鏡検査の発達した今日でも，術前にその確定診断を下すことは未だなお困難な揚合があり，特に粘膜下腫瘍などの術前の質的診断は極めて困難である．最近われわれは3例の胃粘膜下腫瘍に類似した極めてまれな胃結核を経験したので，若干の文献的考察を加え報告する．

　Minutest lesions of the stomach are now being detected in a rapidly increasing number attending on the development in the fields of x-ray and endoscopic diagnosis. Preoperative, accurate diagnosis of these infinitesimal lesions is, however, often accompanied with difficulty, especially regarding preoperative diagnosis of submucosal tumors.

　Recently 3 cases of gastric tuberculosis have been encountered. The first case was operated on under the diagnosis of a submucosal tumor of the stomach, later proved to be gastric tuberculosis by histological examination. The second and third cases, being profited by former experience with the first case, were acurately diagnosed prior to operation as gastric tuberculosis, later confirmed as such by histological examination. One thing common to all three cases was calcified bodies visualized by scout x-ray photographs of the abdomen.

　Tuberculosis of the stomach is closely related with that of other organs, for when there is a tuberculous lesion in other organs, it is more frequently found in the stomach in such a degree that many scholars consider the existence of tuberculosis in organs other the stomach as a prerequisite for the diagnosis of gastric tuberculosis. On the other hand, there have been many reports of gastric tuberculosis in which no active tuberculous lesions could not be demonstrated.

　It has also been shown that a previous history of tuberculosis of other organs is mostly more than years old, as in case 3 in this report. It may take much more time than was presumed for the clinical symptoms of gastric tuberculosis to manifest themselves. It is not always pertinent to deny the existence of gastric tuberculosis solely on the absence of any tuberculous lesion in other organs. It is expected that progress in the technics of cytological and biopsical diagnosis in future will greatly improve the preoperative positive diagnostic rate. It is nevertheless very important never to forget to assume a careful attitude in the interpretation of every single x-ray film.