色素撒布法により鑑別が容易になった潰瘍性びらん性胃炎の1例

A Case of Ulcero-erosive Gastritis Effectively Diagnosed by Dye Spreading Method

症　例

　患　者：U. O.　63歳　男性

　主　訴：胃部不快感，胃集検で幽門前庭部小彎の辺縁不整を指摘されて来院．

　一般所見：表1の如く特記すべき所見はない．

　A 63-year-old man was found by X-ray exmination of the stomach to have a tumorous shadow defect on the lesser curvature of the antrum. The center of the tumor was irregularly depressed, suggesting Ⅱa+Ⅱc type early cancer. Endoscopic findings of the stomach as revealed by G.T.F-A fiberscope were also suggestive of Ⅱa+Ⅱc type early cancer, with its surroundings looking more stiff. When these parts were trasendocospically sprayed and washed away with diluted (0.012%) Evans-blue solution, the protrusion was seen to consist of gathering folds with their tips swollen like club-head. Their raised ends were slightly constricted, but no fusion of the folds was noticed. Their surface was smooth and discolored but it had normal luster. As we were unable to find eroded sign all through the circumfrence Ⅱc-like depression in the center of the elevation and taking into account of multiple and discrete polypous or club-like small protrusions in the surrounding mucosa, we arrived at a diagnosis of ulcero-erosive gastritis.

　Macroscopic findings of the resected stomach and those of histology coincided well with those of preoperative X-ray and endoscopic examinations. This case was thus illustrative of the effectiveness of dye solution spreading.

　In connection with this case, we have described here that this examination procedure is a very effective routine method in endoscopic examination, since when a large amount of diluted and iced Evans-blue solution as thin as 0.012 per cent is employed to wash away a lesion, it becomes more three-dimentional and distinct on account of pooled dye solution. Unevenness of the lesion becomes also more prominent, and a filter effect is to be obtained. We have also referred to ulcero-erosive gastritis (Sano), a lesion that can mimic Ⅱa+Ⅱc type early gastric cancer.