自然脱落した穹窿部孤立性巨大胃ポリープ

A SOLITARY GIANT POLYP IN THE CARDIAC REGION WHICH FALLEN OFF SPONTANEOUSLY

Ⅰ．はじめに

　胃ポリーフ．は前癌病変との考え方から，発見次第手術というのが，最近までの傾向であった．近年単発性のものは，あまり癌化する傾向がみられないとの成績から，経過を長く観察した報告も見られるようになった．しかし経過観察の報告の主眼は，癌化するかどうかにあり，経過観察中胃ポリープが消失したという報告は少なく，われわれの調べた範囲では，1例ポリープの先端が脱落したというのがあった¹⁾．われわれは胃ポリープ発生部位としてはまれな穹窿部にできた1例を経験したが，それが初回胃X線検査から4カ月後の第3回の検査時消失した興味ある例を経験したので報告する．

　A large solitary gastric polyp was experienced in a 43-year-old woman, measuring 3.8×2.8×2.5 cm with a stalk 2cm located on the anterior wall of the cardiac area. Strangely enough, the polyp could not be found at the third x-ray examination done 4 months later; the polyp disappeared spontaneously except stalk. This case has two interesting points; the one is the site of the polyp and the other is its spontaneous disappearance. A polyp in the cardiac region is of rare occurrence; mostly it is located in the prepyloric antrum or in the body. Considered as a precancerous disease, gastric polyp is surgically resected usually whenever it is found. Lately there are some reports that solitary gastric polyp seldom changes to cancer, but long-term follow-up of gastric polyp without operation is as yet insufficient. In Japanese literature, there is only one report of a solitary gastric polyp located in the prepyloric antrum, the head of which had spontaneously fallen off and disappeared. lt is scarcely possible for a polyp in the cardiac area to fall off from the gastric wall because of no peristaltic movement in that area as compared with one in the prepyloric antrum. The cause of disappearance of this polyp is therefore obscure. The patient is said to have caught cold at about two months before the third x-ray examination, complaining of severe cough. Ten days later she had an attack of abdominal colic pain with dizziness. It was considered that circulation within the polyp might have been disturbed by severe cough, later to fall off by necrosis caused by it.