輪状膵と膵・胆管合流異常症を合併した胆嚢癌の1例

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  • A CASE OF GALLBLADDER CANCER WITH ANOMALOUS ARRANGEMENT OF THE PANCREATICOBILIARY DUCTAL SYSTEM AND ANNULAR PANCREAS

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This paper describes a case of gallbladder cancer with anomalous arrangement of the pancreaticobiliary ductal system and amular pancreas.<br> A 65-year-old woman was admitted to the hospital because of epigastric pain. Abdominal CT showed gallbladder enlargement and an annular pancreas. ERCP revealed anomalous arrangement of the pancreaticolbility ductal system without dilatation of the common bile duct, and tapering of the cystic duct. The gallbladder was not visualized and dilated cystic duct was interrupted at the transitional portion to the neck of the gallbladder.<br> Laparotomy was performed with a suspicion of gallbladder cancer. The neck of the gallbladder was thickened, but no malignancy was detected by intraoperative pathological examination. Cholecystectomy and extrahepatic bile duct resection combined with hepatoduodenostomy were performed. However, a poorly differentiated adenocarcinoma invading the subserosal layer was found at the neck of the gallbladder on histological examination. Partial hepatectomy with hepatojejunostomy was carried out five months after the first operation. No residual malignancy was detected in the resected specimen of the second operation. There has been no sign of recurrence as of one year and 7 months after the initial operation and the patient recovered her social activities.<br> Anomalous arrangement of the pancreaticobiliary ductal system is probable genesis of gallbladder cancer, but it is very rate that the annular pancreas is further associated with the former two conditions. So far five cases including this case have been reported in Japan.

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