Nishida K, Kato M, Higashijima M, Takagi K, Akashi R
Department of Internal Medicine, Takagi Hospital, Ookawa City.
Nihon Ronen Igakkai Zasshi. 1995 Dec;32(12):825-9. doi: 10.3143/geriatrics.32.825.
A 93-year-old woman admitted because of epigastralgia. Cholelithiasis, obstructive jaundice, acute suppurative cholangitis and acute pancreatitis were diagnosed on blood chemistry and ultrasonography on admission. We performed emergency PTCD. A calculus 4 cm in diameter was detected at the papilla of Vater and marked dilatation of the common bile duct and pancreatic duct. ESWL was performed because of her age and because endoscopical operation seemed to be difficult. After lithotripsy, PTC and endoscopy demonstrated a diverticulum at the peripapillary portion of the duodenum. Based on analysis of PTC result before and after ESWL, we diagnosed this case as Lemmel's syndrome (obstructive jaundice, acute suppurative cholangitis and acute pancreatitis) caused by a large diverticular enterolith at the peripapillary portion of the duodenum. ESWL treatment of aged patient with an enterolith is safe.
一名93岁女性因上腹部疼痛入院。入院时通过血液生化检查和超声检查诊断为胆结石、梗阻性黄疸、急性化脓性胆管炎和急性胰腺炎。我们进行了急诊经皮肝穿刺胆管引流术（PTCD）。在 Vater 乳头处发现一个直径4厘米的结石，胆总管和胰管明显扩张。由于患者年龄以及内镜手术似乎困难，遂进行了体外冲击波碎石术（ESWL）。碎石术后，经皮肝穿刺胆管造影（PTC）和内镜检查显示十二指肠乳头周围部分有一个憩室。基于对ESWL前后PTC结果的分析，我们将该病例诊断为由十二指肠乳头周围部分的巨大憩室性肠石引起的Lemmel综合征（梗阻性黄疸、急性化脓性胆管炎和急性胰腺炎）。对老年肠石患者进行ESWL治疗是安全的。
