Kuroki Tamotsu, Fukuda Kenzo, Tajima Yoshitsugu, Matsuzaki Sumihiro, Kitajima Tomoo, Furui Junichiro, Kanematsu Takashi
Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
J Hepatobiliary Pancreat Surg. 2005;12(2):143-6. doi: 10.1007/s00534-004-0943-2.
Parapapillary choledochoduodenal fistula is a rare disorder. We herein report a case of parapapillary choledochoduodenal fistula associated with cholangiocarcinoma. A 61-year-old woman was admitted to our hospital for further examination of a liver tumor. She had no clinical symptoms, but computed tomography scans showed an irregularly contoured liver tumor which was histologically confirmed to be adenocarcinoma, by a needle biopsy examination. Duodenal fiberscopy revealed a fistula orifice 1.0 cm proximal to the orifice of the papilla of Vater, and endoscopic retrograde cholangiography through the fistula showed a communication to the common bile duct. Hypotonic duodenography demonstrated reflux of contrast material into the choledochoduodenal fistula. The bile sample collected from the common bile duct showed extremely high levels of pancreatic enzymes, including amylase, phospholipase-A2, and elastase-I. Furthermore, Helicobacter DNA was detected in bile by polymerase chain reaction (PCR) analysis. This experience suggests to us that parapapillary choledochoduodenal fistula may be a risk factor for biliary tract carcinoma, and surgical management is the treatment of choice for this rare condition, even when the patient has no significant clinical symptoms.
乳头旁胆总管十二指肠瘘是一种罕见的疾病。我们在此报告一例与胆管癌相关的乳头旁胆总管十二指肠瘘病例。一名61岁女性因肝脏肿瘤进一步检查入院。她没有临床症状，但计算机断层扫描显示肝脏肿瘤轮廓不规则，经针吸活检检查组织学确诊为腺癌。十二指肠纤维内镜检查发现距十二指肠乳头开口近端1.0 cm处有一个瘘口，通过该瘘口进行的内镜逆行胆管造影显示与胆总管相通。低张十二指肠造影显示造影剂反流至胆总管十二指肠瘘。从胆总管采集的胆汁样本显示淀粉酶、磷脂酶A2和弹性蛋白酶-I等胰酶水平极高。此外，通过聚合酶链反应（PCR）分析在胆汁中检测到幽门螺杆菌DNA。我们的这一经验提示，乳头旁胆总管十二指肠瘘可能是胆道癌的一个危险因素，即使患者没有明显临床症状，手术治疗也是这种罕见疾病的首选治疗方法。
