脾臓に穿通した巨大胃潰瘍の1例

Giant Gastric Ulcer Penetrating into the Spleen, Report of a Case

要旨　患者は52歳，男性．心窩部痛，左側背部痛を主訴に来院．他院にて胃体上部大彎の潰瘍性病変に対するH₂受容体拮抗剤を含む抗潰瘍剤の治療を受けたが改善がみられず，体重減少も4か月で14kgに達したため当院受診，内視鏡的に潰瘍底は巨大な洞窟状の深掘れ潰瘍を認め，周囲の粘膜ひだは著明に腫大していた．CTスキャンにて潰瘍底はほぼ脾臓に達していた．切除標本では胃体上部大彎後壁寄りに深掘れ潰瘍と浮腫状の粘膜ひだが，あたかも腫瘤状に盛り上がってみられ，割面では潰瘍底部で胃壁は完全に断裂し，深く脾臓に穿通していた．周囲は脾臓により挙上された状態で，潰瘍辺縁の粘膜下には著明な浮腫，線維化がみられた．

　A 52-year-old man complaining of left upper abdominal pain for 6 months was admitted to Kitasato East Hospital. He had been treated with H₂ receptor antagonist under the diagnosis of gastric ulcer, without the tendency to heal. Endoscopic examination revealed a giant ulcer with the markedly swollen folds. X-ray examination revealed a large and very deep ulcer surrounded by the marked elevated mucosa. These findings were not specific enough to make a differential diagnosis, especially from non-epithelial tumor such as sarcoma. Resected specimen exhibited a gaint gastric ulcer penetrating deep into the spleen. The surrounding gastric wall was thick with marked fibrosis and edema and in addition compressed by the spleen. There was no malignant tissue histologically.