興味ある膵・胆管合流異常を呈した2例

Confluence Anomaly of the Bile and Pancreatic Ducts, Reportof Two Cases

興味ある膵・胆管合流異常を呈した2症例を経験したので報告する．

　Confluence anomaly of the bile and pancreatic ducts was seen in two patients.

　Case 1: A 65-year-old man complained of pain in the epigastrium since eight years before. This time he had an episode of pain similar to angina pectoris. On close examination, a cyst-like dilatation was seen by DIC corresponding to the site of the choledochus, and the gallbladder was not opacified. ERCP revealed a cyst-like dilatation, measuring 3.5 cm in diameter and containing numerous stones within. The terminal bile duct was narrower, 1.5 cm in width, showing irregular contour. It joined halfway the pancreatic duct at a distance of 1.0cm from the duodenum. In many reports of confluence anomaly the common duct was longer than 1.5cm. In this patient the site of confluence was nearer to the duodenum. The confluent pancreatic duct was also deviated, having complicated shape.

　Case2: A69-year-old woman visited us for detailed examination because of fever, abdominal pain and anemia. As DIC failed to opacify the gallbladder, ERCP wasperformed. Thebileductwasnot dilated. The choledochus was displaced to the left. The cystic duct was strictured in the beginning. The bile duct joined the pancreatic duct at a higher place.

On the hepatic side of the confluent part and from the common duct were seen branches of the pancreatic duct. The present case is important regarding the development of confluence anomaly. Odgers had proposed that the ventral pancreas be connected with the terminal end of the choledochus by at least two joining channels. Our case seems to substantiate the assumption of Oi, who had written, on the basis of Odgers proposal, that in the process of the development of the ventral pancreas the bile duct would surely join the pancreatic duct if the terminal part of the choledochus be obstructed.