先天性胆道拡張症に合併した胆道穿孔の1例 [in Japanese] A CASE OF PERFORATED CHOLEDOCHAL CYST [in Japanese]
Access this Article
Search this Article
症例は, 2歳11カ月,男児.主訴は心窩部痛,嘔吐および発熱.血液検査にて高アミラーゼ血症,腹部US, CTにて肝門部胆管から総胆管下部に至る拡張を認め,膵炎を伴う先天性胆道拡張症と診断し,保存的治療を行った.入院4日後に,突然上腹部膨満と筋性防御が出現し,胆汁性腹膜炎を疑い,緊急開腹を行った.総胆管には嚢腫状拡張,一部に壊死性変化を伴う2カ所の穿孔部を認めた. Tチューブドレナージと腹腔内ドレナージを行い,腹膜炎は軽快した.術後のTチューブ造影にて,膵管胆管合流異常を合併していることを確認した.初回手術3カ月後に,肝外拡張胆管切除術,肝管空腸吻合術を施行した.<br> 穿孔を合併した先天性胆道拡張症の原因,治療について考察した.
A case of perforated choledochal cyst is reported with a review of the literature. A healthy 2-year-old 11 month boy was admitted to the hospital because of acute onset of epigastralgia, vomiting and elevated plasma level of amylase with high-grade fever. Imaging studies revealed a cystic dilatation of the common bile duct, Auggesting a choledochal cyst with pancreatitis. The disease was well controlled conservatively 4 days following admission, when he abruptly developed a severe right upper quadrant abdominal pain. There were abdominal distension, rebound tenderness and muscular defense at the same region. Emargency laparotomy revealed darkly stained ascites and thickened wall of the choledochal cyst with two perforated holes on the anterior wall. Biliary peritonitis due to perforated choledochal cyst was suggested. Peritoneal drainage was performed and a T-tube was placed through the holes into the cyst. A postoperative T-tube cholangiogram confirmed the presence of an anomalous insertion of the pancreatic duct into the common duct. Three months after the initial surgery, the choledochal cyst was resected and the biliary tract was reconstructed by hepaticojejunostomy. An anomalous arrangement of the pancreaticobiliary duct seemed to facilitate reflux of pancreatic secretions into the biliary tree and contribute to cholangitis followed by spontaneous perforation of the choledochal cyst.
- Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 60(11), 3001-3005, 1999-11-25
Japan Surgical Association