| 大腸重複症が併存した胆管非拡張型の膵胆管合流異常症. Anomalous Arrangement of the Pancreaticobiliary Ductal System without Biliary Tract Dilatation Coexistent with Duplication of the Colon | |||||||||||||
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| 74歳, 血清CA19-9が高値を示したため精査目的で来院した。 CT検査では, 肝嚢胞性腫瘍と胆嚢壁の肥厚を認めた。ERCP検査にて, 膵管胆管は, 15mmの共通管を有し, 総胆管の径は9mmであった。胆管非拡張型の膵胆管合流異常症と診断した。術前の全身検索で, 横行結腸の重複を認め, 大腸内視鏡検査では, 横行結腸と回腸との交通を認めた。胆嚢摘出術及び肝腫瘍切除術を施行した。胆嚢内胆汁中のアミラーゼ値は109922IU/Lであった。病理学的所見では, 胆嚢粘膜に高度の異型を認めたが, 悪性所見は認めなかった。. A 74-year-old woman was admitted to our hospital because of a high serum CA19-9 level. Computed tomography revealed a cystic liver tumor and wall thickness of the gallbladder. Endoscopic retrograde cholangio-pancreatography indicated a common channel of 15 mm in length and a common bile duct of 9 mm in width. The diagnosis of anomalous arrangement of the pancreaticobiliary duct without dilatation of the biliary tract was made. From preoperative screening, barium enema examination revealed duplication of the transverse colon. Colonoscope examination revealed communication to the ileum as well as to the ascending colon. Cholecystectomy and hepatic tumor resection were performed. The value of bile juice amylase was 109, 922 IU/L in the gallbladder. By histo-pathological study, severe dysplasia was seen in the mucosa of gallbladder without any signs of malignancy. | |||||||||||||
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