Abstract
Five cases of kissing ulcers in the body of the stomach, longitudinally linear or long oval in shape, have been reported. These ulcers are noticeble because of their unusal form of ulcer and massive gastrointestinal hemorrhage. Four were male and one was female. The patients were old in age, ranging from fifty eight to seventyseven, average sixty-nine, and were admitted to the hospital because of hematemesis and melena. Shock developed in four of them. Three patients were managed by immediate surgery and postoperative courses were satisfactory. One of two patients, treated medically, died. Two patients had been in definite stressful physical condition, prostatectomy and acute pneumonia, prior to developing hemorrhage and could be regarded as acute stress ulcer. Histological examinations of the resected stomach were performed on four patients and revealed that these ulcers were acute ulcers involving submucosa (Ul II) and were located in the intermediate zone. It would be thought that kissing ulcers in the body of the stomach, longitudinally linear or long oval in shape, is one of the characteristic form of acute ulcer involving acute stress ulcer. On the other hand, the acute symmetric ulceration of the antrum of the stomach, which is longitudinally linear in shape, develops in younger age with severe abdominal pain and is followed by rapid healing, is reported by Takagi et al. Our cases would correspond to those of the body of the stomach. It would be thought that, in spite of their some different clinical features, both groups of characteristic ulcers are essentially same lesions and ulcers of our cases develop in the body because of their high location of the intermediate zone. Our cases resemble, in shape of ulcer, Mallory-Weiss syndrome and shoud be differentiated from the latter. The reported cases of Mallory-Weiss syndrome in Japanese literature were reviewed briefly from the standpoint of acute stress ulcer. Some cases, which would be thought to be acute stress ulcer rather than Mallory-Weiss syndrome, are included in them.
