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

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  • A CASE OF CHRONIC CHOLECYSTITIS WITH A DUODENAL STENOSIS MIMICKING GALLBLADDER CARCINOMA

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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.

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