十二指腸球部に脱出した胃巨大囊胞の1例

A Case Report of Huge Stomach Cyst Prolapsing through the Pyloric Ring into the Duodenum

　心窩部痛，悪心，嘔吐を主訴として来院し，レ線および内視鏡的に幽門前庭部に存在する胃粘膜下囊胞の十二指腸脱出と診断し，病理学的にはいわゆる迷入膵に由来する囊胞であった症例を報告する．

　A 28-year-old Japanese man was admitted to the Hospital of Kawasaki Medical College because of a sudden nausea, vomiting and epigastric pain. On physical examination the upper abdomen was slightly distended and a slight tenderness was positive in the mid-epigastrium upon deep palpation though no palpable mass was evident. Laboratory data were within the normal range.

　X-ray study demonstrated in the duodenal bulb a large spherical filling defect with smooth surface, the shape of which was readily changed by pressure.

　On endoscopic examination a huge and smooth-surfaced submucosal tumor with bridging folds was found to be located in the antral lesser curvature at a slightly posterior wall aspect, prolapsing by peristalsis into the duodenal bulb through the pyloric ring. The submucosal tumor showed an apparent notch at a pressure by biopsy forceps and thus a submucosal cyst was suggested.

　Grossly the stomach lesion a huge submucosal cyst measuring 4.5×3.2×3.0 cm in size around the antral lesser curvature, and the submucosal and muscular layers under the cyst apperaed considerably hypertrophied.

　Histological study suggested that the cyst was a retention cyst of a combined aberrant pancreas (Heinrich type II) and enterogenous cyst as defined by E. Palmer.