胃憩室

DIVERTICULA OF THE STOMACH

Ⅰ．はじめに

　胃憩室は胃壁の一部が限局性に胃外に向って嚢状に膨隆したものをいい，消化管憩室の中では最も少なく，食道や十二指腸憩室に比べればかなりまれにしか遭遇しない．

　1611年Moebiusにより初めて記載され，1916年Brownがレ線検査で初めて発見している．外国では，Palmer⁴⁾（1951）が412例，Sommer⁷⁾（1953）は449例を集計しており，Scott and White Clinicでは胃の検査例83,768名中21例の胃憩室を発見している．

　本邦では山形¹⁸⁾（1962）が本邦集計100例と発表しているが，最近，勝原¹³⁾（1968）は山形の文献以後のもの142例を集計して，現在までの本邦胃憩室報告集計は242例と報告しているから，最近5～6年間で飛躍的に発見数が増加していることになり，レ線検査の進歩と普及を裏書きしている．

　筆者も1960年までに5例，1963年までに23例を経験し，全例のレ線像を掲載し報告⁸⁾⁹⁾したが，現在（1968年12月）までに68例（69個）の胃憩室を当病院で発見したので，文献を参照しつつ，胃憩室についてまとめてみたいと思う．本症のほとんどが噴門穹窿部に発生するため見逃される可能性が多い点，胃潰瘍などが胃憩室に酷似するレ線像を示すことがある点，さらに病状の主因は胃憩室に合併する諸疾患によることが多いから合併症の有無に注意する必要がある点などは特に強調したい事柄である．

　1. Of a total of 83,400 patients whose stomachs were examined roentgenologically during 12 years from 1956 through 1968 in St. Mary's hospital, Himeji city, 69 gastric diverticula were found in 68 cases. The incidence is 0.08%, or one in every 1200 persons. This figure is far higher than that reported hitherto, which ranges from 0.03 to 0.04 per cent. Especially of interest is a case of double diverticula in the cardiac region. It is believed to be the first of its kind ever reported in this country.

　As for the sites of 69 diverticula found in 68 cases, 66 of them were located just below the esophago-gastric junction; one on the cardiac greater curvature and the remaining two on the greater curvature of the corpus.

　2. Thirty seven cases were males and thirty one females, but no appreciable difference of incidence is to be found between the two, as the number of males in the out-patient clinic is slightly higher than that of females. People in the third decade are most in number, the youngest being 13 years of age and the oldest, 69. Gastric pouches vary in size from that of a rice kernel to that of a hen egg, and 35 per cent of them are less than a little-finger-tip (1cm in diameter). No apparent relation seems to exist between age and the size of the direrticulum. Individual variation is of major inportance in this respect.

　The diverticula of 3 cases in which diverticulectomy was performed were so thin in their muscle layers that they were all merely nominal three-layered true diverticula; substantially they were in a state of false ones.

　3. Concomitant other diseases are often responsible for various subjective complaints associated with the gastric diverticulum, so that they should never be overlooked.

　4. Diverticula of the stomach, often situated in a region higher than the cardiac orifice, are apt to be missed if a patient is examined in the upright position alone. He must be first examined in the first supine oblique view to recognize a diverticular peduncle; and secondly he must be raised to such an extent as to visualize the diverticulum in its dangling state. These two postures are indispensable to discriminating it from a gastric ulcer. Equally as important is delineation of diverticular stoma in an en-face view. If suspicion should remain, re-examination after some interval becomes necessary. By dint of recent progress in endoscopic study, however, even a diverticular opening high up at the cardia is sufiiciently visualized. Its diagnosis therefore becomes all the more accurate if endoscopy is used jointly with x-ray.