胃・十二指腸重積を起こした胃穹窿部神経鞘腫の1例

A Case of Neurinoma in the Gastric Fundus, Complicating Gastroduodenal Intussusception

　胃重積は，腸重積よりはるかに少なく，そのほとんどは，胃腫瘍の存在が原因となる，最近われわれは，胃穹窿部前壁に発生した神経鞘腫が，周辺胃粘膜を伴って十二指腸内に逸脱した1例を経験したので報告する．

症例

　患者：富○し○ゑ　68歳　主婦

　主訴：突然の心窩部痛と食後の嘔吐

　既往歴：63歳脳硬塞軽快

　家族歴：父糖尿病，母脳卒中

　現病歴：1977年2月中旬に突然心窩部痛が出現し，その後，食後の嘔吐，腹部膨満感など4日間続いたが，絶食によりこれらの症状は消失した．次いで6月18日から22日までと，7月6日から12日まで同様症状出現したため近医を受診し，治療を受けたが軽快せず，絶食により症状は消失した．しかし8月3日から上記症状が出現し，幽門狭窄の疑いのため8月8日当院に入院した．

　A 68-year-old woman visited Gifu Prefectural Hospital because of sudden epigastric pain and postprandial vomiting. She was admitted to the hospital under a tentative diagnosis of pyloric stricture because an elastic hard tumor the size of a man's fist was felt in the epigastrium. Findings of X-ray and endoscopy at the time of pain showed the pylorus displaced to the left with deformed gastric contour due to seemingly shortening of the lesser curvature. Also were seen reddened mucosal folds running from the fornix to the pylorus and a central radiolucency in the duodenal bulb. When she was free from pain, X-ray and endoscopy showed a sessile tumor with a central pit on the anterior wall of the fornix. Diagnosis by biopsy was leiomyoma. Macroscopic findings of the resected specimen were a smooth-surfaced tumor weighing 67 gr, measuring 5.5×4.5×5.0cm, and an ulcer, 1.5×1.5×2.0cm in size, on the topmost part of the tumor. Histologically the tumor was neurinoma. In the course of the disease the pylorus was occluded four times by the prolapse of the tumor, causing sudden epigastric pain, postprandial vomiting and sensation of fullness. These symptoms persisted four to eight days but they were transitory, followed by completely symptom-free periods. Symptoms would then recur, reminding us of ball valve syndrome. A submucosal tumor arising from the fornix rarely prolapses into the pylorus. During the past 20 years only four cases including the present one have been reported.