胺碘酮肝毒性使壶腹癌所致梗阻性黄疸病情复杂化。
Amiodarone hepatotoxicity complicating obstructive jaundice due to ampullary cancer.
作者信息
Collins Anne M, Winter Des C, McCormick Aidan P, Cottell David C, Geoghegan Justin G
机构信息
Department of Surgery and Hepatology, St. Vincent's University Hospital, Dublin 4, Ireland.
出版信息
Hepatobiliary Pancreat Dis Int. 2007 Aug;6(4):435-7.
BACKGROUND
The presence of dual pathology can cause diagnostic dilemmas. We present a case of adenocarcinoma of the ampulla of Vater with concurrent amiodarone hepatotoxicity.
METHODS
Painless jaundice associated with a palpable gallbladder was investigated clinically, radiologically, endoscopically and via liver biopsy.
RESULTS
Liver biopsy showed amiodarone hepatotoxicity. Endoscopic biopsy identified an ampullary adenoma. However, the endoscopic ultrasound and intra-operative findings suggested a malignancy, which was confirmed postoperatively.
CONCLUSIONS
While the classic findings of Courvoisier's Law are borne out in this case, the etiology of jaundice is twofold. Although dual pathology is uncommon it should always be considered.
背景
双重病理情况的存在可能导致诊断困境。我们报告一例 Vater 壶腹腺癌并发胺碘酮肝毒性的病例。
方法
对伴有可触及胆囊的无痛性黄疸进行了临床、放射学、内镜及肝活检检查。
结果
肝活检显示胺碘酮肝毒性。内镜活检发现壶腹腺瘤。然而，内镜超声及术中所见提示为恶性肿瘤，术后得以证实。
结论
虽然本例证实了 Courvoisier 定律的典型表现，但黄疸病因是双重的。虽然双重病理情况不常见，但应始终予以考虑。
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