Marinho Rui, Alves António, Pignatelli Nuno, Nunes Vítor
Division of Hepato-Biliopancreatic Surgery, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.
Department of Pathological Anatomy, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.
J Surg Case Rep. 2019 Jan 31;2019(1):rjy340. doi: 10.1093/jscr/rjy340. eCollection 2019 Jan.
A 24-year-old black male presented with a 1-week obstructive jaundice and intermittent abdominal pain, with no significant weight loss and an unsuspicious abdominal exam. Blood chemistry showed a cholestatic pattern but a complete immunological and tumoral panel (anti-smooth muscle antibody, anti-mitochondrial antibody, anti-nuclear antibody, anti-neutrophil cytoplasmic antibody, anti-Smith, anti-double-stranded-DNA antibody (anti-dsDNA), complement C3/C4, carcinoembryonic antigen, CA 19-9 and IgG4) were all within normal limits. Abdominal ultrasound revealed dilatation of the intra and extra-hepatic bile ducts. CT scan showed an abnormal dilatation of the distal bile duct but no focal enlargement of the head of the pancreas. Endoscopic ultrasound suggested an inflammatory process but the magnetic resonance cholangio-pancreatography favored a neoplastic obstruction of the distal common bile duct. Fine-needle aspiration cytology was insufficient for definitive diagnosis and the patient underwent major surgery. Follow-up with mild exocrine pancreatic insufficiency treated with enzyme replacement.
一名24岁的黑人男性因1周的梗阻性黄疸和间歇性腹痛就诊，无明显体重减轻，腹部检查无异常。血液生化显示胆汁淤积模式，但完整的免疫学和肿瘤学检查指标（抗平滑肌抗体、抗线粒体抗体、抗核抗体、抗中性粒细胞胞浆抗体、抗史密斯抗体、抗双链DNA抗体（抗dsDNA）、补体C3/C4、癌胚抗原、CA 19-9和IgG4）均在正常范围内。腹部超声显示肝内和肝外胆管扩张。CT扫描显示远端胆管异常扩张，但胰腺头部无局灶性增大。内镜超声提示为炎症过程，但磁共振胰胆管造影更倾向于远端胆总管的肿瘤性梗阻。细针穿刺细胞学检查不足以明确诊断，患者接受了大手术。随访发现有轻度外分泌性胰腺功能不全，采用酶替代治疗。
