十二指腸狭窄を呈し胆嚢癌との鑑別が困難であった慢性胆嚢炎の1例 A CASE OF CHRONIC CHOLECYSTITIS WITH A DUODENAL STENOSIS MIMICKING GALLBLADDER CARCINOMA

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胆嚢炎波及による十二指腸球部狭窄の1例を経験した.症例は72歳,女性.嘔吐を主訴に紹介され,上部消化管内視鏡検査で十二指腸球部前壁に易出血性の腫瘤と狭窄を認めた.腹部CTでは胆嚢壁が全周性肥厚し十二指腸球部との境界が不明瞭で,また胆嚢周囲に腹膜播種を疑う小結節がみられた.以上より胆嚢癌の十二指腸浸潤を疑った.術前は根治切除の可能性は低いと考え胃空腸吻合術を予定したが,術中迅速病理で胆嚢が癒着した壁側腹膜および大動脈周囲リンパ節に悪性所見を認めなかったため,肝床切除兼膵頭十二指腸切除術を施行した.切除標本の病理組織診断でも悪性所見なく,胆嚢と十二指腸球部に炎症細胞浸潤,膿瘍ならびに肉芽腫形成を認め,慢性胆嚢炎の十二指腸への波及に伴う球部狭窄と診断された.時として胆嚢炎と胆嚢癌の鑑別に難渋することがあるが,十二指腸狭窄をきたすほどの胆嚢炎の報告例は稀であるため報告する.

A case of chronic cholecystitis accompanied with a duodenal stenosis is reported herein.<br> A 72-year-old woman was referred to the hospital because of nausea, vomiting and appetite loss. On admission, abdominal CT scan showed a thickened gallbladder wall and an unclear boundary between the gallbladder and duodenal bulb. Furthermore there were a few small nodules around the gallbladder, which were suggestive of peritoneal dissemination. Upper gastrointestinal endoscopic examination revealed an easily bleeding papillary projection and stenosis in the duodenal bulb. Clinically, gallbladder carcinoma with duodenum invasion was considered a likely diagnosis. Gastrojejunostomy was scheduled before surgery because of a low possibility of radical operation, but intraoperative frozen section diagnosis disclosed no malignant findings at surrounding tissue such as peritoneum adherent to the gallbladder and a paraaorlic lymph node. Hence, pancreaticoduodenectomy as well as gallbladder bed resection was performed. Microscopic examination also showed no malignant cells and inflammatory cell infiltration, abscess formation, and granuloma were identified in the gallbladder and duodenal bulb. The definite diagnosis of chronic cholecystitis extending to the duodenum with its resultant stenosis was made.<br> Sometimes we have great difficulties in making differentiation between cholecystitis and gallbladder carcinoma, but chronic cholecystitis causing a duodenal stenosis like our case has rarely been reported so far.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association  

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 67(6), 1375-1379, 2006-06-25 

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10018199893
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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