Kikuchi K, Nomiyama T, Miwa M, Harasawa S, Miwa T
Am J Gastroenterol. 1983 Jan;78(1):23-7.
A 49-yr-old male was admitted to our hospital because of epigastric discomfort and a suspected tumor of the stomach on barium meal examination at the Center for Automated Multiphasic Health Test and Services. The tumor shadow of the stomach was initially considered as the "type II" gastric carcinoma according to the Borrmann's classification. Multiple endoscopical and electrocautery cutting biopsies revealed that the tumor occurred in the submucosal layer and was composed of normal pancreatic tissue. A computed tomogram showed a large mass on the pancreatic body which was adjacent to gastric wall. Selective angiography of the celiac trunk revealed that the gastric submucosal lesion was supplied by the transverse pancreatic artery. Endoscopic retrograde pancreatography showed that Wirsung's duct had a divergence in the body of the pancreas and one of the branched ducts headed for the posterior wall of the gastric body. On the basis of these results, a diagnosis was made of the rare pancreatic anomaly, "bifid tail of the pancreas." One of the tails formed the gastric submucosal tumor. This report emphasizes the potential diagnostic value of combined study of endoscopic retrograde pancreatography and computed tomography in determining the presence of pancreatic anomaly.
一名49岁男性因上腹部不适，在自动多相健康检查与服务中心进行钡餐检查时怀疑胃部有肿瘤，遂入住我院。根据Borrmann分类，胃肿瘤阴影最初被认为是“Ⅱ型”胃癌。多次内镜及电灼切割活检显示，肿瘤发生于黏膜下层，由正常胰腺组织构成。计算机断层扫描显示胰体有一巨大肿块，与胃壁相邻。腹腔干选择性血管造影显示，胃黏膜下病变由胰横动脉供血。内镜逆行胰胆管造影显示，主胰管在胰体部有一分支，其中一支分支导管通向胃体后壁。基于这些结果，诊断为罕见的胰腺异常“胰腺双尾畸形”。其中一条胰尾形成了胃黏膜下肿瘤。本报告强调了内镜逆行胰胆管造影和计算机断层扫描联合研究在确定胰腺异常存在方面的潜在诊断价值。
