回虫石形成が経過観察できた胆道内回虫迷入症の1例  [in Japanese] A case of biliary ascariasis successfully protected gallstone formation by ursodeoxycholic acid  [in Japanese]

Access this Article

Search this Article

Author(s)

    • 八辻 賢 YATSUJI Satoru
    • 東京女子医科大学消化器内科 The Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University School of Medicine
    • 白鳥 敬子 SHIRATORI Keiko
    • 東京女子医科大学消化器内科 The Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University School of Medicine
    • 久田 生子 HISADA Shoko
    • 東京女子医科大学消化器内科 The Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University School of Medicine
    • 土岐 文武 TOKI Fumitake
    • 東京女子医科大学放射線科 The Department of Radiology, Tokyo Women's Medical University School of Medicine
    • 林 直諒 HAYASHI Naoaki
    • 東京女子医科大学消化器内科 The Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University School of Medicine

Abstract

症例は77歳の女性,嘔吐と腹部痂痛を主訴に来院右悸肋部に自発痛,圧痛を認め, 好酸球数の上昇と肝胆道系酵素の上昇を認めた. USで総胆管から胆嚢内にかけて運動性のある索状エコーを認めたことから,寄生虫の胆道内迷入を疑いERCを行った.乳頭に迷入した虫体を内視鏡下にバスケット鉗子で摘出を試みたが, 虫体の活動性が強く摘出は困難で,経鼻胆道ドレナージチューブより駆虫薬であるパモ酸ピランテルを注入した.翌日には虫体は胆嚢内に完全迷入し,死虫となった.MRCPにても胆嚢内に迷入した虫体が索状の透瞭像として描出され,便中に回虫卵を確認した.胆嚢内の死虫が次第に不明瞭化するも,第7病日には胆砂が出現した.そこで利胆薬を長期に投与したところ,胆砂は消失した. 回虫の迷入した胆嚢をUSにて6カ月間観察し, 利胆薬が胆石形成予防に奏効したと考えられ,報告した.

A 77-year-old woman was admitted for vomiting and abdominal colic pain. Laboratory studies revealed elevated eosinocyte, AST, ALT, ALP, andγ-GTP. Abdominal ultrasonographic examination (US) showed a moving echogenic strip through the common bile duct to gallbladder. The worm getting into the papilla Vater was confirmed by endoscopic retrograde cholangiography. Although we tried to remove a worm using basket forceps after endoscopic papillary balloon dilatation, it was unsuccessful. Pyrantel pamoate was administered through ENBD tube placed in the common bile duct. On the next day, the dead worm in the gallbladder was observed by US. MR cholangiopancreatography also revealed a liner filling detect indicating the body of worm in the gallbladder, Oral administration of ursodeoxycholic acid (UDCA) was started, and debris finally disappeared about 6 months later. UDCA treatment is successful in protecting gallstone formation caused by Ascaris in the gallbladder.

Journal

  • Tando

    Tando 16(1), 57-62, 2002-03-25

    Japan Biliary Association

References:  17

Cited by:  2

Codes

  • NII Article ID (NAID)
    10008363409
  • NII NACSIS-CAT ID (NCID)
    AN10062001
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    09140077
  • Data Source
    CJP  CJPref  J-STAGE 
Page Top