幽門前部潰瘍の穿通に続発した“Double pylorus”

“Double Pylorus” following Penetration of a Prepyloric Ulcer: A case report

　Double pylorusは稀なもので，文献的にもわずかの報告がみられるにすぎない^1)～7)．しかし，最近ではレントゲン検査技術が進歩し，内視鏡検査も頻繁に行われるようになってdouble pylorusの診断は増加してきている．文献的にはその発生について後天的とするものと先天的とする2つの説がある^1)～7)．また，診断は外科手術の時にやっと得られるものも多いが，一方double pylorusがレントゲン的ないし内視鏡的に特徴ある所見を示したという報告もある．

　著者らの例は幽門前部潰瘍の穿通に続いて発生した後天的double pylorusの1例である．

　A case of a 53 years old male is reported in which a prepyloric ulcer occurred and by penetration into the duodenal bulb a double pylorus developed within 7 weeks. During this time 2 x-ray examinations and 3 gastroscopies were performed and documented the course of this case. The exact diagnosis was established by endoscopy, using a double channel instrument. By inserting 2 plastic tubes through the normal pylorus and the acquired pylorus an injection of dye through both tubes was possible. We watched the confluence of the contrast medium in the duodenal bulb and our diagnosis was confiremd. Biopsy specimens taken from the area of the ulcer and from behind the gastroduodenal band verified the diagnosis histologically. Vagotomy and pyloroplasty were performed. Our case in an example for the morphogenesis of an artificial double pylorus.