興味ある内視鏡所見を呈した胃梅毒の1例

A case report of gastric syphilis, showed unusual gastroscopic findings

Ⅰ．はじめに

　胃梅毒は，1834年Andral¹⁾によって報告されて以来，先天性梅毒，後天性梅毒（第Ⅱ期梅毒，第Ⅲ期梅毒）についての報告は相当数に達しており，わが国においても，片山（1886）²⁾の報告以来岡本（1967）³⁾迄かなり多数の報告がみられる．しかしながら，これらの報告において胃梅毒の診断基準が，はなはだ多様であり，その根拠の評価に対して慎重な態度を必要とするものもある．われわれは，臨床的に胃梅毒を疑うべきであった激しい多彩な胃病変を認め，その切除胃の病理組織学的検索により，肝に定型的ゴム腫を伴った胃梅毒の一例を経験したので報告する．

　A 29 year old housewife complained of severe epigastric pain and vomiting. Gastroscopic examination showed multiple shallow ulcers just above the angulus to the antrum, which were round or irregular in sharp with a dirty yellowish coating. The edges were smooth and sharp, also the surrounding areas a dull reddish orange. The ulcers were creeping and spreading distally. 20 days later, gastroscpic examination showed mucosal destruction just above the angulus as far as the antrum, which was covered with a dull smooth slime and during this time it had changed to a reddish flesh color. Gastrectomy was performed for cancer.

　The case showed unusual gastroscopic findings which were diagnosed as gastric syphilis with typical gumma of the liver by the pathologic examination of the stomach.

　Serology for syphilis was positive. Gastric analysis demonstrated free hydrochoric acid of 41 clinical unit. (Histamine 0.01 mg/kg)

　X-ray examination showed wall irregularity and rigidity, mucosal destruction just above the angulus to the antrum.