A case of gastric ulcer associated with esophageal hiatal hernia showing upside-down stomach, which was difficult to distinguish from malignancy

今回われわれは食道裂孔ヘルニアを原因とするupside down stomach内に発生した高度狭窄型の慢性胃潰瘍を経験したので文献的考察を加えて報告する.症例は75歳女性,嚥下困難で来院.CTで縦隔内に全胃の脱出と胃前庭部の壁肥厚を認めた.上部消化管造影検査で胃は縦郭内に存在し軸捻転を伴うupside down stomach像を呈した.内視鏡検査で前庭部に著明な内腔の狭窄を伴う不整形潰瘍が存在したが,生検ではgroup1であった.胃前庭部の腫瘍を伴う食道裂孔ヘルニアと診断し開腹手術を施行した.縦隔内へ脱出した全胃を腹腔内に戻して幽門側胃切除術+D1郭清+食道裂孔縫縮,残胃横隔膜固定を行った.病理では慢性胃潰瘍と診断され悪性所見は認めなかった.術後経過は良好で胃潰瘍の再発も認めず健在である．

We experienced a rare case of severe stenosis within“Upside-down-stomach”due to esophageal hiatal hernia. We herein report this case with some literature.A 75-year-old women was admitted to our hospital because of dysphagia. CT revealed that the entire stomach dislocated toward the mediastinum and a thickened wall of the antrum of stomach. Upper gastrointestinal series showed an“upside-down stomach”with volvulus of stomach associated with an esophageal hiatal hernia. Gastrointestinal endoscopy showed no malignancy, group 1. Based on these findings, the patient was diagnosed with an esophageal hiatal hernia with ulcerative gastric tumor. We performed distal gastrectomy with D1 lymph-node dissection and repair of the esophageal hiatus and gastropexy. The ulcerative tumor was diagnosed as chronic gastric ulcer having no malignant cell histologically. The patient had a good postoperative course and was discharged with no complication. She is still alive with no recurrence.

食道裂孔ヘルニア　

upside down stomach　

胃潰瘍