胆嚢動脈による偽性総肝管狭窄の1例  [in Japanese] Pseudostenosis of the Common Hepatic Duct caused by Compression of the Cystic Artery  [in Japanese]

Search this Article

Author(s)

Abstract

胆道狭窄は悪性疾患を疑う所見である.胆道は直接的診断が困難であり,間接的な画像診断が行われるため,偽性胆管狭窄の報告がみられる.症例は74歳の女性で,診断は胆嚢腫瘍および総肝管狭窄であった.超音波内視鏡検査では胆嚢腫瘍は最大径12mmであり,また総肝管狭窄は胆嚢癌の総肝管浸潤や胆管癌による可能性が否定できなかったため開腹胆嚢摘出術および術中胆道造影検査を施行した.術中所見では総肝管は胆嚢動脈に圧排されており,狭窄の原因と考えられた.胆嚢動脈の切離後,総胆管を切開し狭窄部を確認するも病変は認められなかった.胆道造影検査でも狭窄像は認められなかった.胆嚢内には12mm大の隆起性病変を認め,深達度mpの早期胆嚢癌であった.今回,我々は胆嚢動脈の圧排によって画像上偽性総肝管狭窄を生じた胆嚢癌の1例を経験したので文献的考察を加えて報告する.

Bile duct way stenosis mimic malignant such as cholangiocellular carcinoma lesions and gall bladder carcinoma invasion. A 74-year-old woman a gallbladder (GB) polyp combined with common hepatic duct (CHD) stenosis was found in admitted for surgery to treat. Preoperative evaluation revealed to have a polypoid tumor 12mm in diameter and relatively smooth CHD stenosis. Because the possibility of malignancy could not be excluded, she underwent open abdominal surgery. We conducted the usual cholecystectomy. The CHD was compressed by the cystic artery, so we thoroughly confirmed the absence of any suspicious CHD lesion by directly inspecting the inner side of the stricture by choledochotomy. The definitive diagnosis of the GB tumor was early GB carcinoma. Although CHD compression by the cystic artery is considered uncommon, we suggest that it should be included in the differential diagnosis of extrahepatic biliary stenosis, especially when biliary stenosis is relatively smooth.

Journal

  • The Japanese journal of gastroenterological surgery

    The Japanese journal of gastroenterological surgery 43(4), 405-410, 2010-04-01

    The Japanese Society of Gastroenterological Surgery

References:  11

Codes

  • NII Article ID (NAID)
    110007593901
  • NII NACSIS-CAT ID (NCID)
    AN00192066
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    03869768
  • Data Source
    CJP  NII-ELS 
Page Top