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“Trench”Ulcer of the Stomach T. Kamada 1 , H. Fusamoto 1 , M. Masuzawa 1 , K. Hiramatsu 1 , O. Fukui 2 1First Department of Internal Medicine, Osaka University Medical School 2Department of Gastroenterology, Natiotral Osaka Hospital pp.523-530
Published Date 1975/4/25
DOI https://doi.org/10.11477/mf.1403112306
  • Abstract
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 It is well known that acute gastric ulcer has a variety in size and shape. The authors experienced two cases with unusual giant ulcers of “trench” shape found in emergency endoscopy and reported in 1973. Then, 12 more cases were encountered until 1974. This report deals with the clinical, endoscopical and histological characteristics of the“trench”ulcer. The characteristic findings in endoscopy were a“trench”ulcer running on the lesser curvature (10 cases) or two in parallel on the anterior and posterior walls (4 cases), from the cardia to the angle. In several cases, these unusual features misled to the initial diagnoses of malignant lymphoma or advanced cancer of Borrmann Ⅲ type. The healing process could be followed in four cases endoscopically. The ulcer was narrowing into a linear one and tapering gradually from its oral portion. Scar formation could be seen about two months later in cured cases and no recurrence was found during the follow-up period. Histological study was performed in three patients. The ulcers extended through the muscularis mucosae (Ul-Ⅱ). Large amounts of edema were seen in all the layers of the stomach. The zone of fibrinoid necrosis was not found in the floor of the ulcer. A large scale fibrinoid degeneration was seen at the edematous submucosal layer. Arteriosclerosis of the serosal vessels was also seen. The surrounding mucosa showed an extensive intestinal metaplasia.

 The pathogenesis of gastric ulcer has been obscure yet. All 14 patients were over 40 years old, and had the complication such as cardiovascular diseases or diabetes mellitus. From these observations, it seems that a circulatory disturbance in the stomach may contribute as one of the important factors to the cause of the“trench”ulcer. The ulcerogenic drugs such as aspirin, anti-inflammatory drugs or corticosteroids may also contribute to its formation.


Copyright © 1975, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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