Ménétrier病の1症例

A CASE OF MÉNÉTRIER'S DISEASE

Ⅰ．はじめに

　本症は1888年のMénétrierの記載以来，各国で症例が報告されているが，1964年までにその数は100例を越えないという．わが国でも数例の報告が見られるが，蛋白漏出が証明された例はまだ少ない．

　しかし1959年Gordon testが開発されて以来，本症の診断は容易になった．最近われわれは胃症状と浮腫を主訴として来院した1例につき，I¹³¹PVPを用いてその胃内への漏出を確認した．そして巨大胃粘膜皺襞と低蛋白血症とよりMénétrier病と確診し，胃切除を行ない良好な結果を得た．以下に本症例を報告するとともに，若干の検討を加えてみることとした．

　A case of Ménétrier's disease was recently encountered in a 38-year-old man. Toward the end of March 1966, he had caught cold followed a few days later by nausea and epigastralgia. On April 23 edema was noticed on his face and in the left lower extremity. On May 2 he had a bout of tetanic attack. Edema was observed in his right lower extremity as well.

　At the time of admission, the liver, of normal soft consistency, was palpated about the breadth of a finger below the costal margin. No anemia was noticed. Of serum electrolytes, K was 2.90 mEq/l, and total serum protein was as low as 4.0 g/dl. Intragastric secretion rate during seven hours after Ⅰ³¹ PVP 58μc had been intravenously injected was 1.1 per cent. The Gordon's test was 8.3 per cent. X-ray examination revealed giant rugae mainly in the greater curvature side of the corpus ven triculi. On Aug. 1, subtotal gastrectomy (two-thirds) was performed followed by Billroth Ⅱ anastomosis.

　Postoperative serum protein levels rose up to 6.9 g/dl on Sept. 12. The Gordon's test on Nov. 21 was 0.74 per cent, a normal figure. Edema in the left lower extermity was still noticiable, suggesting of lymphedema.

　In the resected stomach was noticed mucosal hypertrophy and enlargement of lymph vessels in the lamina propria. Biopsy of the liver demonstrated a number of microabscess around central veins and granulocytic infiltration near Glisson's capsules. Sample excision of V. saphena magna showed no abnormality.

　As of Feb. 1968 the patient is having favorable progress toward recovery.