Dieulafoy潰瘍の1例

Dieulafoy's Ulcer, Report of a Case

要旨　1898年，Dieulafoyは，胃体上部の微小な孤立性粘膜欠損底部において動脈が破綻し，大量の出血を来す疾患をExulceratio simplexと命名した．今回，筆者らもその1例を経験したので報告した．患者は60歳，男性．1982年2月突然嘔気と共に大量の吐下血を来し，緊急人院した．上部消化管の緊急内視鏡を施行し，出血源の検索をしたところ，胃体上部の前壁に露出血管が認められ，同部からの出血であることが確認された．露出血管周囲の潰瘍は小さく，いわゆるDieulafoy潰瘍を疑った．エタノール局注による内視鏡的止血を試み一時止血が得られたが，再出血によりショック状態となり緊急手術を施行した．胃切除標本の病理組織所見は，Dieulafoy潰瘍であった．

　In 1898, Dieulafoy encountered cases in which a ruptured artery at the bottom of a minute solitary mucosal deficit on the upper gastric body caused a massive bleeding, and called this disease entity “Exulceratio simplex”.

　We report here such a case. A 60-year-old man was emergently hospitalized in February 1982 because of sudden onset of massive hematemesis. Urgent endoscopy of the upper digestive tract revealed bleeding from an exposed blood vessel on the anterior wall of the upper gastric body.

　A small perivascular ulcer was suggestive of the so-called Dieulafoy's ulcer. An attempt of endoscopic hemostasis by locally injecting ethanol was successful only for temporary control of the bleeding. Rebleeding occurred leading this time to shock. Emergency operation was subsequently carried out.

　Histopathological examination of the surgical specimen confirmed the Dieulafoy's ulcer.