内容紹介
Summary
This is a case of a 76-year-old man who had no significant past medical or family history. In the current medical history, in November 2017, upper gastrointestinal endoscopy showed a semicircular protruding lesion in the posterior wall of the gastric antrum, and gastric cancer was diagnosed following biopsy. Endoscopic submucosal dissection(ESD)was performed in the same year for the treatment of gastric cancer(cT1aN0M0). Pathological findings after ESD treatment showed invasion into the submucosa requiring non-curative resection. For this reason, laparoscopic pylorus side gastrectomy(D1 dissection)and Billroth Ⅰ reconstruction were performed as additional procedures in March 2018. The patient was discharged on the 10th postoperative day and was followed-up on an outpatient basis. On the postoperative day 14, he was re-admitted with complaints of upper abdominal pain and exacerbation of inflammation. Medical treatment, such as antibiotic administration was followed, however, a high degree of inflammatory response, renal dysfunction, and occult blood in urine were observed. Because of suspicion of vasculitis-related nephritis, the case was diagnosed as anti-GBM antibody type rapid progressive nephritis. We came across a case of rapidly progressive glomerulonephritis after laparoscopic pylorus side gastrectomy performed for early gastric cancer, and hence, We will review the related literature.
要旨
症例は76歳,男性。既往歴および家族歴に特記事項はない。現病歴は,2017年11月に検診目的の上部消化管内視鏡検査で胃前庭部後壁に半周性の隆起病変を認め,生検で胃癌が検出された。胃癌,cT1aN0M0の診断で,12月に内視鏡的粘膜下層剥離術(ESD)を施行した。ESD施行後の病理結果では粘膜下層への浸潤を認め非治癒切除であった。このため,2018年3月に追加切除として腹腔鏡下幽門側胃切除(D1郭清)およびBillroth Ⅰ再建を施行した。経過良好にて術後10病日に自宅退院,以降外来フォローの方針となった。術後14病日に上腹部痛,炎症増悪で再入院となった。抗菌薬投与などの内科的治療を行ったが,炎症反応高値遷延,腎機能障害,尿潜血を認めた。血管炎関連の腎炎などを疑い精査の結果,抗GBM抗体型急速進行性腎炎の診断となった。今回,早期胃癌に対して腹腔鏡下幽門側胃切除術後に急速進行性糸球体腎炎を発症した1例を経験したので,若干の文献的考察を加えて報告する。
目次
This is a case of a 76-year-old man who had no significant past medical or family history. In the current medical history, in November 2017, upper gastrointestinal endoscopy showed a semicircular protruding lesion in the posterior wall of the gastric antrum, and gastric cancer was diagnosed following biopsy. Endoscopic submucosal dissection(ESD)was performed in the same year for the treatment of gastric cancer(cT1aN0M0). Pathological findings after ESD treatment showed invasion into the submucosa requiring non-curative resection. For this reason, laparoscopic pylorus side gastrectomy(D1 dissection)and Billroth Ⅰ reconstruction were performed as additional procedures in March 2018. The patient was discharged on the 10th postoperative day and was followed-up on an outpatient basis. On the postoperative day 14, he was re-admitted with complaints of upper abdominal pain and exacerbation of inflammation. Medical treatment, such as antibiotic administration was followed, however, a high degree of inflammatory response, renal dysfunction, and occult blood in urine were observed. Because of suspicion of vasculitis-related nephritis, the case was diagnosed as anti-GBM antibody type rapid progressive nephritis. We came across a case of rapidly progressive glomerulonephritis after laparoscopic pylorus side gastrectomy performed for early gastric cancer, and hence, We will review the related literature.
要旨
症例は76歳,男性。既往歴および家族歴に特記事項はない。現病歴は,2017年11月に検診目的の上部消化管内視鏡検査で胃前庭部後壁に半周性の隆起病変を認め,生検で胃癌が検出された。胃癌,cT1aN0M0の診断で,12月に内視鏡的粘膜下層剥離術(ESD)を施行した。ESD施行後の病理結果では粘膜下層への浸潤を認め非治癒切除であった。このため,2018年3月に追加切除として腹腔鏡下幽門側胃切除(D1郭清)およびBillroth Ⅰ再建を施行した。経過良好にて術後10病日に自宅退院,以降外来フォローの方針となった。術後14病日に上腹部痛,炎症増悪で再入院となった。抗菌薬投与などの内科的治療を行ったが,炎症反応高値遷延,腎機能障害,尿潜血を認めた。血管炎関連の腎炎などを疑い精査の結果,抗GBM抗体型急速進行性腎炎の診断となった。今回,早期胃癌に対して腹腔鏡下幽門側胃切除術後に急速進行性糸球体腎炎を発症した1例を経験したので,若干の文献的考察を加えて報告する。