胃切除後に十二指腸重積をきたしたVater乳頭部癌の1例  [in Japanese] A CASE OF CANCER OF THE PAPILLA VATER CAUSING DUODENAL INTUSSUSCEPTION AFTER GASTRECTOMY  [in Japanese]

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Abstract

65歳,男性. 14年前に胃潰瘍穿孔にて幽門側胃切除術, Billroth I法再建の手術歴がある.腹部膨満感を主訴に来院.上部消化管造影にて残胃の拡張を認め,内視鏡検査にて吻合部肛門側に絨毛状隆起性病変を認めたが,生検でGroup IIIであった.組織学的に腺窩上皮が乳頭状に増生していたことから,吻合部肛門側十二指腸に発生した腺腫による狭窄と診断し,開腹手術を施行した.手術所見では十二指腸下行脚に鶏卵大の腫瘍が存在し,腫瘍を先進部として十二指腸重積をきたしていた.術中迅速切片にてpapillary adenocarcinomaと判明し,膵頭十二指腸切除術を施行した.術後診断はVater乳頭部癌であった.術後15カ月目の腹部CTで肝転移を認めている.<br> 無黄疸でかつ十二指腸重積をきたした極めて稀な発育形態を示した乳頭部癌の1手術例を経験した.

A 65-year-old man was seen at the hospital because of abdominal distension. There was a previous history of undergoing a distal gastrectomy with Billroth I method for perforation of gastric ulcer 14 years ago. Upper gastrointestinal series revealed gastrectasis of the remnant stomach. Endoscopic study revealed a cilli-ary elevated lesion at the anal side of the anastomosed site. Biopsy disclosed group III.<br> Because of papillary proliferation of lacunar epithelium on a histologic study, it was diagnosed as stricture due to an adenoma arisen in the duodenum at anal side of anastomosed site. Upon laparotomy, a hen's egg sized tumor was present in the descending portion of duodenum which caused duodenal intussusception. Intraoperative frozen section diagnosis revealed papillary adenocarcinoma, and a pancreatoduodenectomy was performed. The definite diagnosis was carcinoma of the papilla Vater. Abdominal CT performed on the 15th month after the operation demonstrated hepatic metastasis.<br> This operated case of papillary carcinoma showing an extremely rare growth pattern that manifested no jaundice but caused duodenal intussusception is reported.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 60(9), 2395-2399, 1999-09-25

    Japan Surgical Association

References:  13

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008496929
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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