Shinagawa Kazuko, Okada Kazuhiko, Yokota Tomotaka, Ueda Akira, Tokimitsu Yoshiharu, Entani Akio, Yasuda Ichirou
Department of Gastroenterology, Toyama Red Cross Hospital.
Third Department of Internal Medicine, University of Toyama.
Nihon Shokakibyo Gakkai Zasshi. 2020;117(7):646-650. doi: 10.11405/nisshoshi.117.646.
A woman in her 70s was admitted to our hospital because of epigastric pain and anorexia. Laboratory evaluations revealed elevated levels of liver transaminases, biliary enzymes, and amylase. CT and MRCP showed dilatation of the bile and pancreatic ducts and a large juxtapapillary diverticulum filled with contents. There were no gallstones or tumors present. Our differential diagnosis included obstruction of the papilla of Vater, so we performed an urgent ERCP. Endoscopic examination showed the juxtapapillary diverticulum filled with food residue;however, we were unable to locate the papilla of Vater. We rinsed out and removed food residue from the diverticulum using a retrieval balloon catheter used for gallstones. After the endoscopic removal of the food residue, the patient's epigastric pain immediately subsided and her cholangitis and pancreatitis improved gradually.
一名70多岁的女性因上腹部疼痛和厌食症入住我院。实验室检查显示肝转氨酶、胆汁酶和淀粉酶水平升高。CT和MRCP显示胆管和胰管扩张，以及一个充满内容物的巨大乳头旁憩室。未发现胆结石或肿瘤。我们的鉴别诊断包括 Vater 乳头梗阻，因此我们进行了紧急 ERCP。内镜检查显示乳头旁憩室充满食物残渣；然而，我们无法找到 Vater 乳头。我们使用用于胆结石的取物球囊导管冲洗并清除了憩室内的食物残渣。在内镜清除食物残渣后，患者的上腹部疼痛立即缓解，胆管炎和胰腺炎也逐渐改善。
