First Department of Surgery, Faculty of Medicine, University of Fukui, Yoshida, Fukui, Japan.
Int J Clin Oncol. 2009 Oct;14(5):460-4. doi: 10.1007/s10147-008-0864-1. Epub 2009 Oct 25.
We describe an unusual case of biliopancreatic fistula, free perforation, and subsequent abscess formation within the lesser peritoneal sac associated with intraductal papillary mucinous carcinoma (IPMC). A 71-year-old man presented with general fatigue and loss of appetite that had persisted for 1 month. Abdominal computed tomography (CT) revealed findings consistent with an intraductal papillary mucinous neoplasm (IPMN) of the pancreas, accompanied by abscess formation in the bursa omentalis. Gastrointestinal fiberscopy revealed a swollen papilla of Vater expanded by sticky mucus, and a communication between the pancreatic duct and bile duct was demonstrated by the injection of indigo carmine solution into the pancreatic duct. Percutaneous transhepatic abscess drainage (PTAD) was performed on the day of admission. After this procedure, the patient was managed for 1 month and supported nutritionally with glycemic control for diabetes mellitus. After admission, the patient had an episode of obstructive jaundice that was treated by retrograde biliary drainage. Pancreaticoduodenectomy with lymph node dissection was then performed. Pathological examination revealed IPMN with patchy, scattered carcinoma of the pancreatic head and uncinate process with the formation of a biliopancreatic fistula. Bile duct epithelium in the area of the biliopancreatic fistula demonstrated atypical papillary epithelium suggestive of tumor invasion.
我们描述了一例不常见的胆胰管瘘、自由穿孔和随后在小腹膜囊中形成脓肿的病例，与胰管内乳头状黏液性肿瘤（IPMC）相关。一名 71 岁男性因持续 1 个月的全身乏力和食欲不振而就诊。腹部计算机断层扫描（CT）显示符合胰管内乳头状黏液性肿瘤（IPMN）的表现，伴有网膜囊脓肿形成。胃肠纤维镜检查显示 Vater 乳头肿胀，被粘性黏液扩张，并且通过向胰管内注射靛胭脂溶液显示胰管和胆管之间存在交通。入院当天进行了经皮经肝脓肿引流（PTAD）。在该操作之后，患者接受了 1 个月的治疗，并通过控制血糖来支持糖尿病的营养需求。入院后，患者发生了阻塞性黄疸，通过逆行胆道引流进行了治疗。然后进行了胰十二指肠切除术和淋巴结清扫术。病理检查显示胰头和钩突有局灶性、散在的 IPMN 伴胆胰管瘘形成。胆胰管瘘区域的胆管上皮显示出非典型的乳头状上皮，提示肿瘤侵犯。
