Sato Y, Shirai Y, Date K, Iwaya A, Hatakeyama K
1st Department of Surgery, Niigata University School of Medicine, Japan.
Hepatogastroenterology. 2000 May-Jun;47(33):636-8.
Although adenomyoma of the gallbladder is not so rare, adenomyoma arising in the bile duct is extremely rare. We herein report a case of partial biliary obstruction due to adenomyoma of the common hepatic duct. A 64-year-old woman was referred to the 1st Department of Surgery, Niigata University School of Medicine for surgical intervention, in whom a biliary stricture in the common hepatic duct was discovered incidentally during a medical check-up for hyperamylasemia in an affiliated hospital. She was asymptomatic without jaundice. Based on her past history of abdominal contusion, the insidious presentation and the smooth biliary stricture on cholangiography, a diagnosis of benign biliary stricture secondary to blunt abdominal trauma was made. A suspicion of malignancy, however, could not be ruled out. Subsequently, she underwent a resection of the extrahepatic bile duct with lymph node dissection in the hepatoduodenal ligament. The patient's postoperative course was uneventful. She was discharged 18 days after the operation. Histology of the resected specimen confirmed the diagnosis of adenomyoma in the common hepatic duct. Clinicians should note to avoid overlooking or misdiagnosing that adenomyoma is a cause of biliary obstruction, although extremely rare.
虽然胆囊腺肌瘤并不少见,但胆管内发生的腺肌瘤极为罕见。我们在此报告一例因肝总管腺肌瘤导致部分胆管梗阻的病例。一名64岁女性因手术干预被转诊至新潟大学医学院第一外科,她在附属医院进行高淀粉酶血症体检时偶然发现肝总管存在胆管狭窄。她没有症状,也没有黄疸。基于她过去的腹部挫伤史、隐匿性表现以及胆管造影显示的光滑胆管狭窄,诊断为钝性腹部创伤继发的良性胆管狭窄。然而,不能排除恶性肿瘤的怀疑。随后,她接受了肝外胆管切除及肝十二指肠韧带淋巴结清扫术。患者术后恢复顺利。术后18天出院。切除标本的组织学检查证实为肝总管腺肌瘤。临床医生应注意避免忽视或误诊腺肌瘤是胆管梗阻的原因,尽管这种情况极为罕见。