Okabe T, Ohwada S, Ogawa T, Takeyoshi I, Sato Y, Kamoshita N, Kon Y, Fukusato T, Ohhara K, Morishita Y
Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan.
Hepatogastroenterology. 1999 May-Jun;46(27):1660-3.
A 79 year-old man was admitted to our hospital because of upper abdominal pain and nausea. A mobile tumor was palpable in the right upper abdomen. Abdominal ultrasonography, computed tomography and celiac angiography revealed a gallbladder tumor. Endoscopic retrograde cholangiopancreatography revealed a fistula 1.5 cm oral to the orifice of the papilla of Vater, dilatation of the common bile duct, and a filling defect in the gallbladder. Pancreatoduodenectomy associated with reconstruction using Imanaga's method was performed under a pre-operative diagnosis of gallbladder carcinoma with choledochoduodenal fistula. The gallbladder contained a tumor and two bilirubin stones impacted in the orifice of the duodenal papilla. Histological studies confirmed that the gallbladder tumor was a mucinous adenocarcinoma and had not infiltrated the bile duct. We speculated that choledochoduodenal fistula stimulated the development of cancer due to chronic irritation from pancreatic juice reflux.
一名79岁男性因上腹部疼痛和恶心入住我院。右上腹可触及一个活动的肿物。腹部超声、计算机断层扫描和腹腔动脉造影显示为胆囊肿瘤。内镜逆行胰胆管造影显示在十二指肠乳头开口上方1.5 cm处有一个瘘管、胆总管扩张以及胆囊内有充盈缺损。在术前诊断为胆囊癌合并胆总管十二指肠瘘的情况下，采用今永法进行了胰十二指肠切除术并重建。胆囊内有一个肿瘤以及两枚胆红素结石嵌顿于十二指肠乳头开口处。组织学研究证实胆囊肿瘤为黏液腺癌，且未侵犯胆管。我们推测胆总管十二指肠瘘由于胰液反流的慢性刺激而促进了癌症的发生。
