急性膵炎に合併した胆道自然穿孔の1例

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  • Spontaneous perforation of the extrahepatic bile duct with acute pancreatitis: Report of a case

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A 63-year-old male alcoholic was admitted to a hospital for upper abdominal pain and vomiting. Under diagnosis of severe acute pancreatitis, the patient was referred to our hospital. PTGBD was performed to treat acute cholecystitis. Cholangiography via PTGBD tube revealed the irregular extrahepatic bile duct wall and leakage of contrast medium, suggesting perforation of the extrahepatic bile duct. Conservative treatment relieved the symptoms, and the patient was discharged. After nine months, ERCP showed that the entire extrahepatic bile duct wall remained irregular. Transiently, the PTGBD tube was removed; however, acute cholecystitis developed, and cholecystectomy was performed. ERCP at 20 months after first admission revealed improvement in stenosis of the entire bile duct, although stenosis at the bifurcation of the anterior/posterior branches remained. The patient has been followed up at the outpatient, clinic without abnormalities in liver function or intrahepatic bile duct dilatation. Spontaneous perforation of the extrahepatic bile duct is rare in adults. We encountered a patient with spontaneous perforation of the extrahepatic bile duct with acute pancreatitis, and performed conservative treatment. Perforation of the extrahepatic bile duct may have been associated with gallstone incarceration; however, specific cholangiography findings suggested the involvement of severe, acute pancreatitis.

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  • Tando

    Tando 18 (4), 525-530, 2004

    Japan Biliary Association

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