急性膵炎で発症した下部胆管癌の1例 A Case of Distal Cholangiocarcinoma Presenting as Acute Pancreatitis

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著者

    • 大橋 拓 Oohashi Taku
    • 新潟大学大学院医歯学総合研究科消化器・一般外科学分野 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
    • 坂田 純 Sakata Jun
    • 新潟大学大学院医歯学総合研究科消化器・一般外科学分野 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
    • 金子 和弘 Kaneko Kazuhiro
    • 新潟大学大学院医歯学総合研究科消化器・一般外科学分野 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
    • 若井 俊文 Wakai Toshifumi
    • 新潟大学大学院医歯学総合研究科消化器・一般外科学分野 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
    • 白井 良夫 Shirai Yoshio
    • 新潟大学大学院医歯学総合研究科消化器・一般外科学分野 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
    • 味岡 洋一 Ajioka Yoichi
    • 新潟大学大学院医歯学総合研究科分子・診断病理学分野 Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences
    • 畠山 勝義 Hatakeyama Katsuyoshi
    • 新潟大学大学院医歯学総合研究科消化器・一般外科学分野 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences

抄録

 胆管癌が急性膵炎の原因となることはまれである.今回,急性膵炎で発症した下部胆管癌の1例を経験したので報告する.症例は65歳の女性で,急性膵炎を発症した.膵炎は保存的治療で軽快するものの,食事の再開で再燃を繰り返した.ERCPでは膵頭部主膵管と下部胆管とに狭窄を認めた.副乳頭からの造影剤の排出を認めなかった.CTでは膵体尾部に主膵管拡張と仮性嚢胞とを認めたが,膵頭部に腫瘤を認めなかった.以上より,主膵管,下部胆管の狭窄を伴う難治性の特発性膵炎と診断された.保存的に治癒が見込めず,小膵管癌による膵炎も否定できないため,膵頭十二指腸切除を施行した.病理組織学的検査で,主膵管浸潤を伴う下部胆管癌(2.4×2.0cm,深達度ss,pPanc<sub>2</sub>)と診断された.十二指腸主乳頭には異常を認めなかった.以上より,自験例における急性膵炎の原因は,下部胆管癌の主膵管浸潤による膵管内圧上昇と考えられた.

Cholangiocarcinoma is a rare cause of acute pancreatitis. We herein report a case of distal cholangiocarcinoma presenting as acute pancreatitis. A 65-year-old woman was admitted to an affiliated hospital for treatment of acute pancreatitis, which was resistant to conservative management and recurred following dietary intakes. ERCP depicted strictures of both the main pancreatic and distal bile ducts within the head of the pancreas; the patency of the minor duodenal papilla was obscure. Computed tomography (CT) scan of the abdomen disclosed dilatation of the main pancreatic duct and some pseudocysts in the body and tail of the pancreas; no mass was depicted in the head of the pancreas. A diagnosis of idiopathic pancreatitis with strictures of both the main pancreatic and distal bile ducts was made. As the pancreatitis was resistant to conservative management and the concomitance of small pancreatic cancer could not be ruled out, a Whipple pancreaticoduodenectomy was performed. Histologic examination of the resected specimen revealed a distal cholangiocarcinoma, measuring 2.4×2.0 cm, with marked pancreatic invasion. Although the tumor invaded the main pancreatic duct within the head of the pancreas, the ampulla of Vater was not involved. The above findings suggest that the acute pancreatitis in this case was attributable to increased intraductal pressure due to involvement of the main pancreatic duct by a distal cholangiocarcinoma.

収録刊行物

  • 日本消化器外科学会雑誌

    日本消化器外科学会雑誌 45(1), 60-66, 2012

    The Japanese Society of Gastroenterological Surgery

各種コード

  • NII論文ID(NAID)
    130004908084
  • 本文言語コード
    UNK
  • ISSN
    0386-9768
  • データ提供元
    J-STAGE 
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