すい頭部癌との鑑別が困難であった胆道バイパス術後の出血性十二指腸球後部潰ようの１例

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  • An Operated Case of Hemorrhagic Duodenal Ulcer at the Posterior Bulb with Difficulty in Differentiation from Cancer of the Pancreatic Head.

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A 55-year-old woman was seen at the hospital because her therapy for gastric ulcer was unsuccessful at other hospital. Upper gastrointestinal endoscopy showed ulcer with fur occupying a three-forth of the circumference of the duodenum covering from the superior angle to descending part. The patient was admitted to the hospital. Abdominal ultrasonography and an enhanced CT scan disclosed a tumor of the uncus of pancreas, and swelling of the extrahepatic bile duct and lymph node No16. In addition, obstructive jaundice and abnormalities in the hepatic function appeared. There was a possibility of pancreatic cancer or duodenal cancer and the patient was operated on. At surgery, the descending part of the duodenum and pancreatic head had formed a mass which was thought impossible to be radically resected, and so a division of the duodenum at the bulb was performed, followed by a duodenojejunostomy and a biliary bypass operation. The postoperative course was uneventful and a shrinkage of the tumor was observed. However, tarry stool and anemia developed 4 months after the operation which demanded another operation. When the descending part of the duodenum was incised, a 4cm ulcer with exposed vessels in its center was present on the pancreatic side, and a pancreatoduodenectomy was performed. The patient's postoperative course was uneventful.

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