Upside down stomachを呈した食道裂孔ヘルニアに4多発胃癌を合併した1例 A CASE OF QUADRUPLE GASTRIC CANCER WITHIN UPSIDE DOWN STOMACH DUE TO ESOPHAGEAL HIATAL HERNIA

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食道裂孔ヘルニアは比較的頻度の高い疾患だが,全胃が脱出し,軸捻転を伴うupsidedown stomachは稀で,さらに胃癌合併例は非常に稀である.症例は85歳の女性.労作時呼吸困難と動悸にて入院.胸部単純写真およびCTで左胸部への消化管の逸脱を認めた.上部消化管造影で左横隔膜上に全胃が脱出したいわゆるupside down stomach像を認めた.上部消化管内視鏡で胃体部に2型の胃癌を,前庭部に山田III型のポリープを2個認めた.以上より胃癌合併食道裂孔ヘルニアと診断し,幽門側胃切除術と食道裂孔縫縮術を施行した.切除標本で前庭部の病変はいずれも高分化型腺癌と診断,この他に胃体下部前壁に術前診断できなかったIIa型の高分化型腺癌を認め4多発癌であった.<BR>Upside down stomachを呈する食道裂孔ヘルニアではその解剖学的特徴から十分な術前精査が困難で,慎重な術前診断が必要と思われた.

Although esophageal hiatal hernia occurs in a relatively high incidence, esophageal hiatal hernia presenting upside down stomach with volvulus in which the entire stomach prolapsed is rare, especially that associated with multiple gastric cancer.<BR>An 85-year-old woman was admitted to the hospital because of dyspnea on effort and palpitation. Chest plain x-ray film and a chest CT scan revealed deviation of the gastrointestinal tract into the left thoracic part. Upper gastrointestinal series visualized so-called upside down stomach in which the entire stomach prolapsed on the left diaphragm. Upper gastrointestinal endoscopy revealed type 2 gastric cancer in the gastric body and two polyps of Yamada′s type III on the antrum. From these findings, esophageal hiatal hernia with gastric cancer was diagnosed and a distal gastrectomy and plication suture of the esophageal hiatus were performed. On the resected material, all antrum lesions were diagnosed as well differentiated adenocarcinoma. Besides these lesions, type IIa well differentiated adenocarcinoma in the anterior wall of the lower part of gastric body which had not been diagnosed preoperatively was confirmed, quadruple gastric cancer being disclosed.<BR>We have difficulty in conducting sufficient preoperative exploration for esophageal hiatal hernia manifesting upside down stomach due to its anatomical characteristics, and hence careful attitude for preoperative diagnosis would be mandatory.

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  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 62(2), 376-380, 2001-02-25

    日本臨床外科学会

参考文献:  6件中 1-6件 を表示

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各種コード

  • NII論文ID(NAID)
    10008388042
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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