成人にみられた肥厚性幽門狭窄症の1例

A CASE OF HYPERTROPHIC PYLORUS STENOSIS SEEN IN AN ADULT

Ⅰ．緒言

　成人にみられる肥厚性幽門狭窄症はきわめて稀な疾患とされ，レ線および内視鏡技術の発達にもかかわらず術前の確定診断はなお困難である．最近われわれはレ線透視および内視鏡所見より幽門部胃polyposisを疑い，術後切除胃標本の組織学的検査により肥厚性幽門狭窄症と診断された1例を経験したので報告する．

　Polyposis of the stomach was found at x-ray examination of a woman 57 years of age complaining of postprandial fullness of the stomach since Sept. 1966. At subsquent x-ray study in the hospital, to which she had been admitted for thorough examination, a polypoid shadow defect was observed in the pylorus. The GTF study of the stomach, of normal tonicity with no retardation of barium meal evacuation, revealed ridge-like elevations with smooth surface and of normal color near the pyloric ring, which had normal peristaltic movement. Under a provisional diagnosis of polyposis of the stomach, she was transferred to the surgery department, where later she underwent gastrectomy.

　Several tumors of elastic hardness were palpated during operation ranging from the pyloric antrum down to the ring without any swelling of regional lymph nodes.

　In the resected stomach, hypertrophy of the pyloric ring was noted all around. On its cut section, its slight intraluminal stricture and outstanding hypertrophy of the pyloric muscles were observed. A part of the lesser curvature neighboring the ring was most hypertrophic; the muscle layer alone was 1.1 cm thick.

　Inflammatory reaction was histologically manifest in the gastric mucosa of the pylorus, as was recognized by infiltration by plasma cells, lymphocytes and leucocytes. The muscularis mucosae as well as the muscular coat itself was hypertrophic associated with slight inflammatory cellular infiltration.

　Since the normal muscle layers of the pyloric ring are from 0.3 to 0.8 cm thick, as reported by many investigators, this case was diagnosed as hypertrophic pyloric stenosis, a disease rare in adult, because the pyloric ring of this patient was more than 1 cm in thickness.