Gastritis cystica polyposaの1例

Gastritis Cystica Polyposa, a Case Report

　残胃病変のなかで，最近にわかに注目されはじめた病変の1つに，Gastritis cystica polyposaがある．比較的稀な症例で，本邦でもまだ数例の報告例をみるのみである，われわれは，この稀な症例を手術する機会を得たので，ここに発生機点を含めた文献学的考察を加えて報告する．

症　例

　症　例：I. Y.　63歳　男性

　主　訴：上腹部痛

　既往歴：入院の約10年前，胃潰瘍にて胃切除術（Billroth Ⅱ法）をうけたと述べている．他に特記すべきことなし．

　家族歴：癌にて死亡あるいは手術をうけたものなし．他に特記すべきことなし．

　現病歴：1976年8月中旬から，食事とは関係なく心窩部痛を来たすようになった．特に夜間に心窩部痛がつよく，運動時には痛みのため胸苦しくなってきたため，同年9月上旬国立小倉病院内科を受診し精査をうけた．その結果，胃腸吻合部の悪性病変を疑われて，手術適応検討のため同院外科へ10月上旬に入院した．

　A report is made of surgically treated gastritis cystica polyposa, one of the lesions arising in the remnant stomach that has been highlighted recently. Presented here is also a review of the literature with an inquiry into the mechanism of occurrence.

　A man aged 63, who had undergone gastrectomy about ten years before because of peptic ulcer, visited us in the middle of Aug. 1976 with a chief complaint of epigastric pain. GI series and gastric endoscopy revealed a protruding lesion at the site of anastomosis. Biopsy specimens taken from the lesion was histologically confirmed as Group Ⅳ. We resected the gastric stump at the site of anastomosis along with the adjacent part of the jejunum under a diagnosis of stomal cancer. Macroscopically, the resected specimen showed a protrusion on the gastric mucosa at the anastomosed site. Prolapsing into the jejunal lumen, it surrounded the site of anastomosis in an almost ring-like fashion. Histologically the lesion was confirmed as gastritis cystica polyposa as proposed by Littler et al.

　This lesion is said to occur more often in the remnant stomach surgically treated by the Billroth Ⅱ method. The mechanism of its occurrence is reportedly considered reactive changes of the fundic gland mucosa caused by regurgitation of the duodenal juice.