胃空腸横行結腸瘻および結腸潰瘍のみられたZollinger-Ellison症候群の1例

Zollinger-Ellison Syndrome with a Gastrojejunocolic Fistula and Colic Ulcer, Report of a Case

　Zollinger-Ellison症候群（以下，ZE症候群）は1955年に初めて報告されて以来，欧米では診断や治療について多数の報告がみられる．本邦では1961年村田らにより初めて報告されてから次第に症例数が増加しつつあり，当教室でもこれまで4例のZE症候群を経験している．今回は，このうち胃空腸横行結腸瘻と結腸潰瘍を伴った極めてまれな1例について報告する．

　A 51 year-old woman was admitted to our hospital with complaints of left hypochondralgia radiating to the back, and melena. She had undergone subtotal gastrectomy with Billroth Ⅱ for gastric ulcer in 1967. At the second operation, resection of the anastomotic portion with Roux-en Y anastomosis and partial resection of the transverse colon with colo-colostomy had been carried out for stomal ulcer with gastrojejunocolic fistula. Laboratory tests at admission were within normal limits except for anemia and hypoproteinemia. The gastric secretory test showed hypersecretion of both basal acid output (14.2 mEq/h) and maximal acid output (12.5 mEq/h). Plasma gastrin levels following calcium, secretin and glucagon provocation tests demonstrated the pattern of Zollinger-Ellison syndrome.

　Examination of the upper gastrointestinal series and barium enema revealed a gastrojejunocolic fistula, a stomal ulcer penetrating to the abdominal wall and deformity with stenosis in the descending colon. Endoscopic examination of the remnant stomach showed a large niche in the anterior wall.

　As extensive exploration failed to identify a gastrin-producing lesion, total gastrectomy, distal pancreatectomy and left hemicolectomy were performed. The resected specimen showed a penetrating ulcer in the stomal portion, giant folds in the remnant stomach and an ulcer with stenosis in the descending colon.

　Radical operation including that for internal fistula and colic ulcer is necessary for Zollinger-Ellison syndrome with such complications.