Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
Dig Endosc. 2010 Oct;22(4):319-21. doi: 10.1111/j.1443-1661.2010.01013.x.
A 75-year-old man who underwent choledochojejunostomy for gallstones 30 years ago was hospitalized for general malaise. Abdominal computed tomography revealed marked dilation of the intrahepatic bile duct in the right lobe and an image of a hypervascular tumor. Endoscopic retrograde cholangiography using double-balloon enteroscopy (DBE) showed a filling defect that was localized to the right hepatic bile duct. Furthermore, the scope was able to readily pass through the anastomosed site of the choledochojejunostomy and, therefore, we observed the interior of the bile duct using the same scope. We obtained an image showing a whitish, papillary-like tumor, and a biopsy of the tumor rendered the pathology of intraductal papillary mucinous carcinoma. Direct cholangioscopy using DBE is a useful diagnostic tool, particularly in patients with a past history of choledochojejunostomy.
一位 75 岁男性，30 年前因胆囊结石行胆肠吻合术，因全身不适住院。腹部 CT 显示右叶肝内胆管明显扩张，呈富血管性肿瘤样图像。使用双气囊小肠镜（DBE）进行经内镜逆行胰胆管造影（ERCP）显示充盈缺损局限于右肝内胆管。此外，内镜可顺利通过胆肠吻合口，因此我们使用同一内镜观察胆管内部。我们获得了一张显示白色、乳头状肿瘤的图像，对肿瘤进行活检得出了胆管内乳头状黏液性癌的病理结果。DBE 下直接胆管镜检查是一种有用的诊断工具，尤其适用于有胆肠吻合术病史的患者。
