球部多発性Brunner腺腺腫・胃迷入膵および球部潰瘍瘢痕を合併した症例

A Case of Gastric Aberrant Pancreas Associated with Multiple Polyps of the Duodenal Bulb and a Healed Doudenal Ulcer

　十二指腸鏡の発達は目ざましく，十二指腸潰瘍・乳頭部病変・逆行性胆膵管撮影による胆膵病変などが明らかにされてきている．

　十二指腸球部の隆起性病変¹⁾は悪性のものは稀で，多くは良性のものであるために胃に比べてあまり興味がもたれていない．著者らは，胃幽門大彎側にbridging foldを伴った隆起性病変と十二指腸球部に山田分類Ⅲ～Ⅳ型の多発性隆起性病変を伴った症例を経験し，手術により胃粘膜下腫瘤は迷入膵であり，十二指腸球部病変はBrunner腺腺腫と判明した症例につき，十二指腸鏡検査と選択的腹腔動脈撮影の成績を含めて報告する．

　We report a case with aberrant pancreas in the greater curvature of the gastric pylorus associated with multiple polyps of the doudenal bulb, which consisted of Brunner's gland proven histologically.

　A 41-year-old married female was admitted to our hospital with complaints of abdominal distension, dull epigastric pain and nausea. Physical examination disclosed no abnromalities except for a small palpable mass in the epigastrium. Routine examinations of peripheral blood revealed no abnormalities. Upper gastrointestinal series showed a smooth-margined, half-round filling defect in the greater curvature of the pyloric region and multiple half-round filling defects in the duodenal bulb.

　Gastroendoscopic examination revealed a submucosal tumor with bridging folds in the greater curvature of the pyloric region and duodenoscopic examination showed multiple polyps on the posterior wall of the doudenal bulb.

　A Billroth Ⅱ hemigastrectomy was perfomed. Histopathologic study of resected specimens revealed that the submucosal tumor in the pyloric segment consisted of aberrant pancreatic tissue (Heinrich type Ⅱ) and polypes in the doudenal bulb arose from adenomatous hyperplasia of Brunner's glands. There was a healed ulcer in the doudenal bulb.