蛋白漏失を伴った消化管Polyposisの1例―胃polyposis，十二指腸polypおよび直腸polyp

A Case of Gastrointestinal Polyposis with Protein Loss: gastric polyposis, duodenal polyp and rectal polyp

はじめに

　筆者らは低蛋白血症を伴った特異な消化管po1yposisの1例を経験し，RISA試験により胃内への蛋白漏失機転の存在を確認しえた．胃全摘により血清蛋白像の著明な改善を得たので，若干の考察を加えて報告する．

　This report concerns with gastrointestinal poIyposis, gastric protein loss, hypoproteinemia and anemia found in a 34-year-old male patient who improved after total gastrectomy.

　Gastrointestinal series disclosed multiple polyposis of the stomach, single duodenal and rectal polyps. lnitital laboratory studies revealed hypoproteinemia and anemia. Total serum protein level was as low as 5.0g/dl. Hemoglobin was 50% (Sahli). Intravenous RISA test revealed hypercatabolism of serum protein with resultant loss into the gastric juice. RISA half life was shortened to 4.5 days. ¹³¹I-radioactivity was significantly found in the gastric juice. Gastric hypersecretion and hyperacidity were shown by augmented histamin test. Hepatic and renal functions were normal.

　The patient was diagnosed as a case of protein-losing gastro (entero) pathy and total gastrectomy was performed (esophago-jejunostomy). Soon after the operation he suffered from serum hepatitis, but improved two months later. Serum protein level rose up to 7.0～7.6 g/dl two months after operation.

　Improvement of hypoproteinemia and anemia has continued.

　In the resectecl stomach showing multiple polyposis, microscopic findings revealed proliferation and cystic dilatation of the gastric pits. Edema, inflammatory cell infiltration and enlargement of lymph vessels were also noted in the lamina propriae mucosae.