結核性リンパ節炎による総胆管狭窄症の１例

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  • A case of choledochal stenosis caused by tuberculous lymphadenitis.

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A 30-year-old man was admitted to our hospital with right hypochondralgia and mild liver dysfunction. Abdominal X-ray and plain computed tomography revealed a smallcalcified lesion located at the hepatoduodenal ligament, endoscopic retrograde cholangio-pancreaticography revealed smooth compression stenosis at this lesion. He had suffered from tuberculous lymphadenitis of the neck 5 years before, and a tuberculosis skin test was positive. Operative findings included 2 lymphnode swellings (2 cm in diameter) around the choledochalduct. After cholecystectomy and resection of the lumphnodes, the common bile duct was dilated by Hegar's dilator and a T-tube was inserted. Tubercle baccilus was identified from these lymphnodes by the smear test. Intermittent liver dysfunction occurred during the postoperative course. The patient was discharged 46 days after surgery. The surgically treated cases of biliary tract stenosis caused by tuberculous lymphadenitis, are rare. Only 8 cases have been reported in the Japanese literature, and sporadically a few cases abroad. Lymphnode resection was performed in the 8 cases reported in Japan, and choledochojejunostomy was performed in three of those cases.

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