胃切除後残胃に発生した柿胃石の1例

A Case of Phytobezoar Due to Persimmon Found in the Gastric Remnant

　上部消化管レ線検査の増加にともない，胃内異物の報告は近年増加の傾向にあるが，胃石は比較的まれな疾患と考えられ，ことに手術後の残胃に発生したという報告は極めて少ない．今回筆者らは，胃潰瘍により胃切除を受けてから3年を経て残胃に発見された柿胃石の1例を経験したので報告する．

　This paper deals with a ease of persimmon bezoar seen in a remnant of the stomach removed three years before.

　A 38-year-old man had previously visited the authors' hospital with a complaint of epigastric pain. In August 1965 he had a bout of sudden severe pain in the abdomen and hematemesis. Under the diagnosis of perforated peritonitis due to gastric ulcer he underwent gastrectomy. His recovery was uneventful. However, in December 1968 he had an episode of epigastrie pain and feeling of fullness in the abdomen, so that he was referred for further evaluation of his symptoms. At the initial examination, a hard, mobile tumor was in the left hypochondrium. In the general examinations there was nothing abnormal other than occult blood in the feces. Gastric juice (Histamin provocation) showed hypersecretion and hyperacidity. X-ray examination of the stomach resected three years before in its two-thirds by Billroth method Ⅱ revealed an oval foreign body about the size of a hen-egg movable within the gastric lumen. A niche was also visualized on the lesser curvature near the anastomosis. Endoscopic examination by means of GTF-A disclosed a dark brown foreign body of long oval shape, presumably to be a bezoar. Total excision of the gastric remnant revealed two ulcer lesions as well. Of black surface, the bezoar measuring 5.0×2.5×3.0 cm and weighing 21 gr, had elastic soft consistency. Its cut surface was grayish white. A part of the bezoar was examined by Prof. Sakamoto of Agricultural Department, Hokkaido University. The bezoar proved to be a phytobezoar due to persimmon kernels.

　This case is of interest because no previous history of overeating of persimmon was elicited. In addition to hyperacidity seen in spite of the remnant stomach, decreased secretive ability of proteolytic enzymes is assumed to be responsible for the formation of bezoar.