<症例>慢性膵炎に対する再手術として膵全摘施行の1例

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A 47-year-old male suffering from the symptoms of chronic relapsing pancreatitis due to long-term alcoholic abuse was noted to have diffuse pancreatolithiasis, narrowing of the distal bile duct and the duodenum associated with swelling of the pancreatic head and cholelithiasis. On March 2,1983,the patient underwent resection of the pancreatic tail, plasty of the orifice of main pancreatic duct and cholecystectomy to relieve his symptoms and to remove pancreatolith. Dehiscence of incisional wound of the duodenum at the 8th postoperative day required emergency Billroth II gastrectomy and catheter duodenostomy. After satisfactory recovery, he was discharged on September 3,1983. A fistula with intermittent discharge developed at the site of drainage scar on October, 1983. The patient was readmitted on July 9,1984 because of pain in the right upper quadrant of the abdomen and the persisting fistula. A fistulogram revealed a duodenocutaneous communication, whose duodenal opening was the duodenal stump of previous gastrectomy. Spontaneous closure of the fistula was thought to be impossible because of the narrowing of the duodenal second portion. The severity of chronic pancreatitis and the presence of long-standing fistula were considered to be indications for total pancreatectomy. On August 1,1984,total pancreatectomy preserving the spleen was performed. His postoperative course was uneventful with an adequate control of diabetes mellitus. After discharge on October 7,1984,the patient is doing well and has a moderate work without weight loss, diarrhea or other serious complaints. The results of education of diet control and insulin injection seem to be satisfactory. Although the indication of total pancreatectomy for chronic pancreatitis is restricted, symptoms of this patient might be unrelieved without application of this surgery.
近畿大学の論文
1985-06-25

<症例>慢性膵炎に対する再手術として膵全摘施行の1例

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