コンテンツメニュー

A case of gastric cancer was detected on survey of liver abscess

山口医学 Volume 62 Issue 1 Page 49-53
published_at 2013-02-01
B030062000108.pdf
[fulltext] 2.74 MB
Title
肝膿瘍の発症により診断し得た胃癌の1例
A case of gastric cancer was detected on survey of liver abscess
Creators Hanazono Tadasuke
Creators Noguchi Norio
Creators Mori Kenji
Creators Sakaida Isao
Source Identifiers
Creator Keywords
胃癌 肝膿瘍
症例は70歳代男性.2001年に大腸癌と診断され,右半結腸切除術を施行されている.2011年11月,発熱,上腹部痛が持続するため近医受診.腹部エコー及び腹部CTで肝膿瘍を認めたため精査,加療目的のため当院紹介,入院となった.入院後施行したMRIで肝S5下縁に肝膿瘍を疑う腫瘤及び胃前庭部に腫瘤を認めた.肝膿瘍に対しては経皮経肝膿瘍ドレナージ及びスルバクタム・セフォペラゾン(SBT/CPZ)の投与を行い,膿瘍の縮小が得られた.膿瘍の培養ではSt. milleri Grpが検出され,細胞診はclassⅠであった.また,上部消化管内視鏡検査を施行し,胃角部前壁に2型進行胃癌が発見されたため,当院外科転科となり幽門側胃切除術が施行された.大腸癌に合併した肝膿瘍の報告は散見されるが,胃癌との合併の報告は比較的稀である.大腸癌に肝膿瘍が合併する機序としてはmucosal barrierの破壊が原因による経門脈性感染と考えられているが,胃癌でも同様に経門脈性感染が原因の一つと考えられた.肝膿瘍の原因として上部消化管疾患の検索も必要と考えられた.
A-70-year-old man complained of fever and upper abdominal pain. Computed tomography and ultrasonography of the abdomen revealed a solitary liver abscess in the anterior segment of liver. He was referred to our hospital. Abdominal MRI showed liver abscess and tumorous lesion of the stomach. Administration of antibiotics and percutaneous drainage of liver abscess was performed; then, the size of the abscess decreased. Cytology of the abscess revealed no malignant cells and Streptococcus milleri was cultured from the abscess. After the abscess diminished, we performed esophagogastroduodenoscopy and found a type 2 gastric carcinoma on the anterior wall of the angular part; therefore, distal gastrectomy was performed. Several investigators reported the association between liver abscess and colon cancer. It is thought that bacteria are transportally transferred to the liver from the mucosal injury caused by colon cancer. It might be possible that liver abscess occurs in patients with gastric cancer. In conclusion, to identify the cause of liver abscess, examinations of gastrointestinal tract should be performed.
Subjects
医学 ( Other)
Languages jpn
Resource Type journal article
Publishers 山口大学医学会
Date Issued 2013-02-01
File Version Version of Record
Access Rights open access
Relations
[ISSN]0513-1731
[NCID]AN00243156
Schools 医学部