胃潰瘍を伴った胃石の1例と文献的考察

A Case of Bezoar Associated with Gastric Ulcer and References to Medical Literature

　胃石は一般に比較的稀な疾患とされている．本邦では1908年三宅が藺草よりなる胃石を報告したのが最初である．しかし胃腸疾患におけるレントゲン，内視鏡診断の普及にともないその報告が増加してきている．筆者らは潰瘍と胃石を合併した症例を経験したので，その概略を述べ，併せて過去10年間の文献的考察を加えて報告する．

症例

　患　者：K. U.　67歳　男

　主　訴：上腹部痛．

　家族歴，既往歴：特記すべきことなし．

　嗜好物：酒は1日2合程度，煙草約20本．その他，特に好き嫌いはないが，柿は以前よく食べていた．

　現病歴：昭和47年9月頃より，心窩部不快感が出現した．同年9月末，近医受診し加療中であつたが，11月末，強精の目的にて某注射液1日5Ampを連続3日間，計15Amp服飲した．その直後，上腹部痛が出現し，特に空腹時著明であったが，症状軽快せず，本年2月本院受診し，入院した．

　A man aged 67 complaining of discomfort in the epigastrium in September 1972 was brought under medical treatment. To make himself sexually more vigorous, he drank at the end of November a certain injection liquid for three days. Immediately thereafter he began to complain repeatedly of epigastralgia. He was hospitalized in February 1973 for thorough checkup. At that time no abnormality was detected except tenderness over the epigastrium and hyperchlorhydria of the gastric juice. x-ray examination of the stomach showed a mobile tumor along with a niche in the greater curvature side of the antrum. Endoscopy revealed a bezoar associated with ulcer. In the following month an operation on the stomach (Billroth I) was performed. The bezoar was dark purple, 5×3×4 cm in size and 195 gr. in weight, Histologically, the ulcer was Ul IV with no malignant cells demonstrated. An analysis of the bezoar showed that, unlike the compositions of the swallowed injection liquid, it was composed of Al, Mg, Ca, etc. It could not be traced to its origin.

　For the past approximately ten years bezoar associated with ulcer have accounted for 32 percent of all cases of gastric bezoars, and it was mostly seen in the age group 40-49. The male outnumbered the female in a ratio of 2.3 : 1. The predilection site of concomitant ulcer was in the region of the angle. The above instance is different in its location from that of the usual gastric ulcers; and it can be suspected that the existence of bezoar had something to do with the formation of ulcer.