A Case of Duodenal Papillary Carcinoma Complicated by Repeated Acute Pancreatitis.
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概要
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We present a patient with duodenal papillary carcinoma who repeatedly developed acute pancreatitis preoperatively. The patient was a 65-year-old male. In February 1997, the patient consulted a local hospital due to vomiting, high fever, and jaundice. With the diagnosis of obstructive jaundice, percutaneous transhepatic biliary drainage (PTBD) was performed, revealing a distal bile duct obstruction. Because duodenal papillary carcinoma was diagnosed based on endoscopic findings, the patient was admitted to Kurume University Hospital. Hypotonic duodenography (HDG) disclosed a protruding lesion with an irregular surface in the descending part of the duodenum, resulting in a diagnosis of positive duodenal invasion (du<SUB>1</SUB>). Because computed tomography (CT) demonstrated a protruding lesion on the medial side of the second portion of the duodenum, positive pancreatic invasion (paric<SUB>2</SUB>) was diagnosed. On March 18 and April 22, sudden abdominal pain, leukocytosis, and an increase in serum amylase were noted. CT revealed that the pancreas was diffusely enlarged, showing an ill-defined boundary between the pancreas and adipose tissue and fluid collection. On CT, the lesion was evaluated as Grade 3 and moderate. For treatment, pancreatic enzyme inhibitors and antibiotics were intravenously injected. Peritoneal perfusion was concomitantly performed during the second treatment. Because symptoms remitted thereafter, a pylorus preserving pancreatoduodenectomy (PpPD) was carried out. The postoperative histologic examination revealed negative pancreatic invasion. Concerning the etiology of acute pancreatitis, not pancreatic invasion, but impaction of the liberated tumor mass in the common canal was considered responsible for the repeated pancreatitis because the tumor showed a cauliflower-like shape.
- 久留米大学医学部 The Kurume Medical Journal 編集部の論文
著者
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AOYAGI Shigeaki
Department of Cardiovascular Surgery, Kurume University School of Medicine
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HARA MASAO
Department of Mathematical Sciences, Tokai University
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Sakai Takenori
Department Of Surgery Kurume University School Of Medicine
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IMAYAMA HIROYASU
Department of Surgery, Kurume University School of Medicine
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Tamae Tsuyoshi
Department Of Surgery And Division Of Hepatic Surgery Kurume University School Of Medicine
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Hashino Kotaro
Department Of Surgery Kurume University School Of Medicine
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Furukawa Satoshi
Department Of Aquatic Bioscience Graduate School Of Agricultural And Life Sciences The University Of
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Sajima Shuichi
Department Of Surgery Chikugo City Hospital
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Fukuda Shuichi
Department Of Cardiovascular Medicine Graduate School Of Medicine University Of Tokyo
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Sato Shinji
Department Of Accelerator And Medical Physics National Institute Of Radiological Sciences
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Kawabata Masahiro
Department Of Biochemistry The Cancer Institute Of Japanese Foundation For Cancer Research (jfcr) An
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Kinoshita Hisafumi
Department Of Surgery And Oncology Graduate School Of Medical Sciences Kyushu University
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Hashimoto Mitsuo
Department of Chemistry Faculty of Arts and Sciences Ibaraki University
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Hara Masao
Department of Industrial Chemistry, Faculty of Engineering, Yamaguchi University
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