Hirata S, Yamaguchi K, Ichikawa J, Izumo A, Ohtsuka T, Chijiiwa K, Tanaka M
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
J Hepatobiliary Pancreat Surg. 2001;8(2):179-81. doi: 10.1007/s005340170044.
Most patients with ampullary carcinoma have obstructive jaundice without cholangitis. We experienced a patient with ampullary carcinoma who presented with obstructive jaundice and cholangitis, probably because of an accompanying periampullary choledochoduodenal fistula. A 77-year-old Japanese man had jaundice, high fever, and upper abdominal pain and was diagnosed, at another hospital, with obstructive cholangitis. On admission to our hospital, his symptoms and signs had subsided spontaneously. Abdominal ultrasonography showed cholecystolithiasis and dilatation of the common bile duct. Duodenoscopy showed an ulcerating tumor at the oral prominence of the ampulla of Vater and a periampullary choledochoduodenal fistula at the bottom of the ulcer. Biopsy from the fistula showed well differentiated adenocarcinoma. With a diagnosis of ampullary carcinoma with fistula formation, the patient underwent pylorus-preserving pancreatoduodenectomy. The diagnosis was confirmed by histology. This communication presents a unique case of ampullary carcinoma that caused obstructive jaundice, which subsided spontaneously but was associated with cholangitis caused by the divergent effects of the periampullary choledochoduodenal fistula formed by the carcinoma.
大多数壶腹癌患者有梗阻性黄疸但无胆管炎。我们遇到一名壶腹癌患者，其表现为梗阻性黄疸和胆管炎，可能是由于伴有壶腹周围胆总管十二指肠瘘。一名77岁的日本男性出现黄疸、高热和上腹痛，在另一家医院被诊断为梗阻性胆管炎。入院时，他的症状和体征已自行消退。腹部超声显示胆囊结石和胆总管扩张。十二指肠镜检查显示在 Vater 壶腹的开口处有一个溃疡性肿瘤，在溃疡底部有一个壶腹周围胆总管十二指肠瘘。瘘管活检显示为高分化腺癌。诊断为壶腹癌伴瘘管形成后，患者接受了保留幽门的胰十二指肠切除术。组织学检查证实了诊断。本文报道了一例独特的壶腹癌病例，该病例导致梗阻性黄疸，黄疸自行消退，但与癌肿形成的壶腹周围胆总管十二指肠瘘的不同影响所致的胆管炎有关。
