肝蛭(Fasciola sp.)の人体異所寄生の1例
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概要
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1)長崎県南高来郡在住の15才の女性が悪心,嘔吐,上腹部痛を主訴として来院し,膵臓嚢腫と診断された患者から手術時その嚢腫内に肝蛭寄生を認めた症例を報告した.尚,本症例は長崎県に於ける人肝蛭症の最初の報告例である.2)摘出した虫体は内部構造の精査により明らかにFasciola sp.と同定された.然し,睾丸,子宮および卵子などの臓器は何れもその形状を殆んど止めておらず,従って本虫体は比較的強い障害を受けていたものと思われる.3)本吸虫はF. giganticaと推定されるが確定的な同定は困難であった.4)本症例の感染経路などについては現在検討中である.稿を終るに当り御指導,御校閲をいただいた片峰大助教授ならびに第1外科の辻泰邦教授に感謝致します.また虫体の観察に際し御教示ならびに貴重なFasciola hepaticaの標本の贈与を受けた渡辺昇蔵博士に謝意を表します.尚,本論文の要旨は第26回日本寄生虫学会南日本支部大会において発表した.In the present paper, we describe a human case of liver fluke (Fasciola sp.) infection occuring in a 15 years old female who lives in Nagasaki Prefecture. The patient was admitted to the University Hospital with the complaints of nausea, vomiting and epigastric pain. On the physical examination, about a hen's egg sized tumor was palpable in the right hypochondricus region. Various laboratory examinations were performed on the liver function tests, amylase activity in serum and urine, blood, stool, urine and so on. But most of them revealed the normal value excluding slight eosinophylia. Finally, the patient was clinically diagnosed as pancreas cyst from the findings of hypotonic duodenography and selected coeliac arteriography. We could surgically find a cyst, 4.5×3.0×2.5 cm in size, adhering to the duodenum wall and the head of pancreas. A flat fluke worm was detected from this cyst. The fluke worm was long leaf-shaped, measuring 27 mm in length by 6.8 mm in maximum width, ratio of length to breadth being about 4:1 in the value of the fixed specimen. Ventral sucker was larger than oral sucker, size of those measuring 1.50×1.41 mm and 1.01×0.78 mm respectively. Branched intestinal caeca with numerous lateral diverticula were present fully in the internal cavity of the worm. Particularly, the secondary intestinal branches were more complicated than that of Fasciola hepatica. Distinct features of uterus and testis could not be clearly recognized, but some deformed eggs were found at the portion of uterus. Cuticular scales with fine longitudinal striations could be seen all over the surface of whole body. From the characteristics mentioned above, this fluke worm was identified as Fasciola sp. which resembled Fasciola gigantica.
- 1974-03-31
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