A Case of Obstructive Icterus Caused by Incarceration of a Pancreatic Stone in the Common Channel of the Pancreatobiliary Ducts.
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概要
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A 51-year-old man had repeated admissions and discharges from the hospital for alcohol dependence and alcoholic hepatitis. Thereafter, with a diagnosis of chronic pancreatitis, he was examined on an outpatient basis. He presented with right hypochondriac pain as the chief complaint, and was admitted to the hospital because of a suspected acute exacerbation of chronic pancreatitis. Pyrexia and jaundice were present from about the 5th hospital day, and he was admitted to Kurume University Hospital with a diagnosis of obstructive icterus. Percutaneous transhepatic biliary tract drainage (PTBD) was immediately performed. A roentgenogram revealed moderate dilatation of the extrahepatic bile ducts and stricture of the intrapancreatic common bile duct. No calculi were observed in the gallbladder or bile ducts by ultrasonography of the abdominal region. The main pancreatic duct was dilated to 10mm, and a strong echo, probably a calculus, was observed in the main pancreatic duct. Pancreatoduodenectomy was performed with a diagnosis of stricture of the common bile duct due to chronic pancreatitis with a pancreatic stone. Examination of the excised specimens revealed a rigid pancreatic head; and when the common bile duct was incised, no stricture was observed. A milk-white calculus about 10mm in diameter was observed in the common channel of the lower portion of the common bile duct. The orifice of the pancreatic duct was also observed at the same site. The common channel was about 20mm long, and malfusion of the pancreatobiliary ducts was observed. The obstructive icterus was due to an impaction of the pancreatic stone at the confluence of the pancre-atobiliary ducts. The calculus was composed of calcium carbonate, and the histopathological findings in the pancreas showed chronic pancreatitis.
- 久留米大学医学部 The Kurume Medical Journal 編集部の論文
著者
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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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Nakayama Toshimichi
Department Of Surgery Shizuoka Red Cross Hospital
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Kinoshita Hisafumi
Department Of Surgery And Oncology Graduate School Of Medical Sciences Kyushu University
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SHIBATA Junji
Department of Applied Chemistry, Graduate School of Engineering, Nagoya University
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SOU Hironobu
Department of Radiology, University of Yamanashi
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OGAMI NOBUKI
Department of Surgery, Kurume University School of Medicine
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