胃内回虫症の5例―レ線像を中心に

ROENTGEN DEMONSTRATION OF ASCARIS LUMBRICOIDES IN THE STOMACH

Ⅰ．はじめに

　1947年，Stoll¹⁾が世界各地の報告にもとづいて地球上における寄生虫感染状況を注意深くまとめ“This Wormy World”と題し発表した．この論文は蠕虫類が人類に非常に淫浸していることを明らかにし入々を驚かせた．なかでも回虫感染者は世界人口の約30％に及んでいた．当時の日本ではそれさえはるかに上まわる地域が多かったが，最近では，回虫の感染率は減少し都会地では皆無であるかのように思われている．しかし第1表に示すように岡山県でも地域的には未だ相当の感染率を示しており，胃腸症状を訴え，来院した患者の消化管レ線検査時に胃，小腸内の回虫陰影を証明することがある．ここに報告する症例は，最近，第1表で示した建部町で認めた2症例，岡山市内の1症例と西大寺市保健所管内で行なわれた間接レ線による胃集団検診2,068名中，邑久町で認められた2例である．

　In the year 1967 the incidence of ascariasis on the average of a selected group for the survey in Okayama Prefecture, Japan, was 5.3%. Its infection rate shows a decreasing tendency since 1945, except in farming communities where the incidence is 10.2%, still a high figure. Ascarides are on that account still observed, though infrequently, in the stomach as is shown by a series of x-ray examinations of the gastrointestinal tract recently conducted by the authors.

　The present report describes clinical symptoms and characteristic x-ray features of ascariasis in five cases recently encountered.

　Case 1 A 49 years old man.

　The patient was admitted to hospital suffering from recurring attacks of epigastric pain. No clear abdominal signs were found at physical examination. In the x-ray study of the stomach, a shadow of a mature Ascaris was clearly demonstrated in it (Fig. 1). On compression, the same worm was shown with its tail (Fig. 2), indicating that it was a mature male. Abdominal pain soon stopped as ascariasis was successfully treated.

　Case 2 A 25 years old female.

　She complained of intermittent attacks of cramping abdominal pain lasting for one month.

　Gastric mucosal patterns at x-ray examination were those of acute gastritis and hyperperistalsis. She was hospitalized one month later because of recurrent bouts of epigastric pain and nausea.

　No organic lesion was demonstrated in the radiograph of the stomach, but besides its increased motility, filling defects looking like round worms were detected in the stomach as well as in the duodenum. By effective treatment against ascariasis one male and two female Ascarides were passed in the stool.

　Case 3 A 39 years old man.

　The patient entered the hospital with a history of recurrent episodes of upper abdominal pain associated with nausea. The pain was transitory and of irregular intervals, with no relation to the kind of food ingested. Though at firuoroscopy the shadow of a round worm was overlooked, it was clearly visualized in x-ray film as a small, round radiolucency in the antrum, indicative of an immature Ascaris (Fig. 5). By several consecutive x-ray studies many Ascaris worms were found in the intestine. One of them, as shown by an arrow, injested barium in its digestive tract (Fig. 6).

　Recognition of the Ascaris worm in the stomach by mass survey indirect radiograms.

　In a series of mass survey of the stomach by car-loading apparatus, Ascarides were found, of 2,068 cases of mass examination of the stomach, in two cases in the stomach and in one in the duodenal bulb.

　In Fig. 7 (70 years old female) many Ascaris worms are observed in the body of the stomach and in the intestine. Fig. 8 (55 years old male) shows an Ascaris worm in the duodenal bulb discovered by a mass survey indirect roentgenogram.