胃幽門前庭部急性潰瘍の長期観察例

Long-term Observation of Acute Gastric Ulcer in the Pyloric Antrum

症例

　患　者：29歳　男性　運転手

　主　訴：心窩部痛

　家族歴・既往歴：特記事項なし

　現症歴：睡眠も充分にとらず，極限的な過労の中で業務に従事していたところ，1976年8月18日午後より，心窩部の重圧感が嘔気を伴って発生し，次第に激しい疼痛となり数回の嘔吐もみられた，近医の注射を受けたが軽快せず，夜に至り激痛に耐えかねて来院した．

　The patient is a male, chauffeur, aged 29. On August 18, 1976, he was hospitalized because of severe epigastric pain which developed abruptly. The pain was almost gone in three days. The gastric examination immediately after the onset revealed tonic narrowing of the antrum, and endoscopy disclosed there edematous narrowing and multiple blackish hemorrhagic erosions. One week after the onset the blackish erosions were replaced by multiple ulcers with coat, and several days later, marked symmetric ulcers were seen on the anterior and posterior wall of the antral region with the lesser curvature in the center. These were healed in a month, leaving ulcer scars behind. About three years after the healing, the cicatrices still remained. In this case neither relapse nor development into chronic ulcer was visible.

　Investigation on 103 cases of acute lesions in the pyloric antrum revealed that three findings: 1) abrupt severe epigastric pain, 2) tonic narrowing of the pyloric antrum, and 3) multiple ulcerous lesions in the same part, seemed to be mandatory conditions for the development of this disease at the beginning.

　The observation of the disease course in the author's cases having three findings suggests that the acute ulcerous lesions in the pyloric antrum might be different from the so-called peptic ulcer, and there be three types in its disease course: 1) healing in the stage of hemorrhagic erosion (mild case), 2) turning of hemorrhagic erosion into ulcer without cicatrization (moderate case), and 3) developing into the symmetric ulcers leaving marked cicatrices behind (severe case). This kind of ulcer has never been accompanied by massive hemorrhage or perforation, and completely healed in about a month without relapse or transition to chronic ulcer.