十二指腸憩室の穿通が原因と考えられた膵頭部腫瘤の1例  [in Japanese] A CASE OF A TUMOR OF THE PANCREATIC HEAD PROBABLY CAUSED BY PENETRATION OF DUODENAL DIVERTICULUM  [in Japanese]

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Abstract

症例は39歳,男性.主訴は嘔吐,心窩部痛,体重減少.近医にて十二指腸腫瘤を指摘され当院に入院した.上部消化管造影では十二指腸第1部から第2部にかけての壁の不整像を認め,内視鏡検査では同部位の粘膜の発赤と狭小化が認められた.また,腹部CT検査では十二指腸壁の肥厚と十二指腸第2部と膵頭部の間に境界明瞭な20mm程の嚢腫状部分が認められた.十二指腸壁に起因する炎症性腫瘤が疑われたが悪性の可能性も完全には否定できず,膵頭十二指腸切除術(PD-IIA)を施行した.切除標本では,膵頭部に固い腫瘤を触知し,割面は白色痕痕状で一部cavityを形成していた.病理所見では高度な線維化が主体であり嚢腫状部分は線維化を伴った十二指腸壁内に存在しており膵内線維化巣と連続していた.以上より十二指腸憩室の穿通後の反応性変化が疑われた.十二指腸憩室は頻度の高い疾患であるがその穿孔(穿通)例は少い.文献的考察を加えこれを報告した.

A 39-year-old man complaining of vomiting, epigastric pain, and body weight loss was referred to the hospital because he was pointed out a duodenal tumor at another hospital. Upper gastrointestinal series revealed irregular intestinal wall covering from the first to second portions of duodenum. Endoscopic study disclosed redness and narrowing of the mucosa at the same sites. Abdominal CT scan revealed thickening of the duodenal wall and a demarcated cystic lesion about 20mm in size between the second portion of duodenum and pancreatic head. Inflammatory tumor arising in the duodenal intestinal wall was suspected, but a possibility of malignancy could not be completely ruled out. So a pancreatoduodenectomy (PD-IIA) was performed. On the resected material, a hard tumor was palpable at the pancreatic head. The section presented white cicatrical appearance with a part where a cavity was formed. Pathologically, severe fibrosis was the main finding, the cystic part was present in the duodenal wall with fibrosis, and communicated with fibrosis foci in the pancreas. From these findings, reactive change after penetration of duodenal diverticulum was suspected. Although duodenal diverticulum is a disease with a high frequency, clinical cases of its perforation or penetration are few. This uncommon case is reported together with a review of the literature.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 63(4), 904-907, 2002-04-25

    Japan Surgical Association

References:  6

Codes

  • NII Article ID (NAID)
    10008618902
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    13452843
  • Data Source
    CJP  J-STAGE 
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