胃潰瘍が心膜腔に穿破し，心膜気腫を発症した胃心膜瘻の1例

Gastropericardial Fistula by Gastric Ulcer Resulting in Pneumopericardium, Report of a Case

要旨　患者は42歳の女性．突然の悪心，嘔吐後の胸部不快感，呼吸困難，発熱を主訴に受診．胸部X線写真上，心膜気腫，縦隔気腫を認め，著明な炎症所見もあり，心膜炎，縦隔炎と診断した．胸部CT所見より，その原因として胃心膜瘻の存在が推定された．絶食，中心静脈栄養管理，抗生剤H₂ブロッカー投与，心膜ドレナージを施行し，改善した．胃内視鏡検査を施行したところ，胃体上部前壁側に深い下掘れ型潰瘍を認め，ドレナージチューブから注入した色素液の潰瘍底からの流出を確認した．瘻孔閉鎖後，収縮性心膜炎による心不全が出現したが，保存的治療で改善した．胃潰瘍の合併症としての胃心膜瘻の報告はまれであり，若干の文献的考察を加え報告した．

　Fistula from the gastric cavity to the pericardial cavity is very rare. We report a case with gastropericardial fistula resulting from gastric ulcer. A 42-year-old woman was admitted to our hospital because of chest discomfort and dyspnea with high fever followed by vomiting. Chest X-ray film revealed pneumopericardium as well as pneumomediastinum. The patient was diagnosed with pericarditis and mediastinitis based on these findings and routine laboratory tests. Esophagography was not contributable to the diagnosis, but a gastropericardial fistula was suspected by CT scan. After the treatment with pericardial drainage and intravenous hyperalimentation including antibiotics and H₂-blocker, endoscopic examination of upper gastrointestinal tract was performed. A small deep ulcer with converging folds was observed in the anterior wall of the upper gastric body. A dye solution which was injected into the pericardial cavity via the drainage tube leak out through the ulcer. This patient was successfully treated conservatively.