胃梅毒―第Ⅱ期梅毒における胃粘膜病変の観察

TWO CASES OF GASTRIC LESIONS IN SECONDARY SYPHILIS WITH SPECIAL REFERENCE TO ITS CLONICAL OBSERVATION WITH BIOPSY, ENDOSCOPIC AND X-RAY EXAMINATION

Ⅰ．はじめに

　胃梅毒の胃X線像・胃内視鏡像は，病期によって多彩な所見をしめし，胃梅毒に特有なものはない．また急性腹症の一つとも考えられるから，他の胃疾患との慎重な鑑別診断が要求される．

　1834年にAndral¹⁾が胃梅毒を記載してから現在まで，その報告は決して少なくはない．しかしその病期と診断基準は一様でなく，また診断の確定が手術後や剖検後のものが多い．ある限られた病期の，しかも比較的経過し固定した臨床像のみの観察に終っている．

　近年，梅毒感染後の比較的早期の胃粘膜を正確に診断し，経過を観察した報告²⁾がある．われわれは最近，第Ⅱ期梅毒における胃粘膜病変を，胃X線・内視鏡・生検で，病変の消失まで追跡した2症例を経験している．

　Syphilitic changes chiefly of ulcerous nature were found in the stomachs of two housewives, 22 and 24 years old respectively, resulting from luetic infection contracted only two months before. Findings of gastric syphilis as observed by x-ray, endoscopy and biopsy examinations were followed up through various phases of healing under treatment. By studying these two cases, it is presumed that there exist some common characteristic features of gastric syphilis regarding the disease itself as well as its specific stages of evolution. One of the clinical manifestations of secondary gastric syphilis is sudden onset of extreme epigastric pain associated with postprandial recurrent vomitus. The pain is often so severe that initial diagnoses of both cases were either gastric or duodenal ulcer or else acute pancreatitis. It is very noteworthy that symptom patterns of this disease sometimes begin in so sudden a manner as to simulate “acute abdomen”. Roentgenologically, a concentric stricture was seen in the pyloric part; in the first instance, a cancer or polyposis was suspected; in the second, a depressed lesion was found concurrent with a large, shallow ulcer. As for its endoscopic findings, the mucosa over and around the lesion looked dim, tinged with dark red, in one case polypoicl, in the other suggesting a confluence of ulcer lesions of various sizes, having yellowish white exudate in the base of ulcer. They seemed of softer consistency as compared with gastric cancer or sarcoma. Gastric biopsy indicated that syphilitic granulating tissues having plasma cell and eosinophile cell infiltration fairly correspond with those of syphilitic erythema on the external surface of the body as well as of erosions of the vaginal part of the uterus.

　In the determination of the diagnosis of gastric syphilis, coincidence of histological findings obtained by biopsy with those of other luetic lesions is no less important than its positive serological tests.

　Decreased gastric secretion as well as hypoacidity observed in both cases returned to normal according as affected lesions improved. Of particular interest is the fact that mucosal lesions of the stomach in the second instance, especially its ulcer, gradually diminished in size attending on the resolution of syphilitic erythema before the inception of antiluetic treatment.

　In the past some cases of gastric syphilis have been operated on in this country, but no such expeditious procedure seems necessary.