嘔吐に続発した食道噴門接合部出血の2例

Two Cases of Bleeding from the Cardioesophageal Junction Following Vomiting

　頻回の嘔吐のために食道あるいは胃噴門部などに急性の亀裂様裂創を生じ，これが出血源となって大量の吐下血を惹起する疾患は，Mallory-Weiss症候群として知られているが，比較的稀な疾患で，わが国ではこれまでに22例の報告を見るに過ぎない．

　今回われわれは，Mallory-Weiss症候群に極めて類似した食道噴門接合部の出血性潰瘍の2症例を経験したので報告する．

　The first case is a 31-year-old male school teacher and the second, a famer aged 63. Both were habitual drinkers. They visited us complaining of hematemesis occasioned by vomiting. Conservative treatment was no avail for checking bleeding and after several days blood pressure became so low as to necessitate surgical intervention. In the first case was seen an ulcer due to laceration at the cardio-esophageal junction, from which bleeding was ascertained. The patient then underwent cardiectomy under a tentative diagnosis of Mallory-Weiss syndrome. In the second case a lesion resembling Dieulafoy ulcer at the cardio-esophageal junction accounted for bleeding. Cardiectomy was likewise performed. Both cases were free from liver cirrhosis or portal hypertension.

　Histologic examination of the bleeding site in both cases revealed rupture of dilated veins accompanied with thrombi, giving one an impression of burst paper baloons.

　From these facts it is assumed that: (1) Mallory-Weiss syndrome, or acute ulcer caused by lacerations in the cardiac esophageal junction due to pressure changes within the gastric lumen, shows in its healing process of ulcer not always patterns of laceration. At times ulcer may show a shape simulating Dieulafoy ulcer. (2) Mallory-Weiss syndrome, hitherto attributed to bleeding from ruptured small arteries synchronous with lacerations, can well be produced as well by bleeding from ruptured veins within the lacerated part as was seen in our case. (3) Not only can bleeding in Mallory-Weiss syndrome occur from the veins, but also from localized changes of luminal pressure in the veins attendant on the act of vomiting.