慢性血液透析患者に発生した十二指腸乳頭部癌の１例

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  • A Case of Ampulla Carcinoma in a Patient on Maintenance Hemodialysis.

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A 75-year-old man maintained on hemodialysis for 3 years was admitted to the hospital for an elevation of ALP (455U/l). Abdominal ultrasonography revealed a dilatation from the intrahepatic bile duct to common bile duct. Abdominal CT scan revealed a tumor in the common bile duct. Duodenoscopy showed an elevation of the ampulla 2cm in diameter. Biopsy specimen was diagnosed as well-differentiated adenocarcinoma. ERCP and PTC revealed an eggshell defect at the lower dilated common bile duct. Pancreatoduodenectomy with D2 lymph node dissection was performed. Histologically, the tumor consisted with adenocarcinoma, Ac×b-Bi, pap, INFβ, intermediate, ly1, v1, pn0, pancla, d1, hw0, ew0, n0. Postoperative course was eventful for a minor leakage at the pancreatojejunostomy started in the 8th day after the surgery. The patient was discharged from the hospital 60 days after the operation. It is possible that patients with only ALP elevation and intrahepatic dilatation have advanced ampulla carcinoma as pancla, dl pathologically. Therefore, upper gastroduodenoscopy including ERCP is nessesary. This case suggests that intensive perioperative care enables regular hemodialysis patient with chronic renal failure to undergo highly stressful operation such as pancreatoduodenectomy, without critical complications.

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