胃に異所開口した重複胆管の1例

Duplication of the Common Bile Duct Emptying into the Stomach, Report of a Case

　胆管が胃に開口することは，文献的に知られてはいるがまれである．われわれは，本来の総胆管とは別に，胃体下部小彎にも胆管が異所開口していた重複胆管の1例を経験したので報告する．

　Patient: A 29-year-old woman.

　Personalhistory: During early childhood a problem with malnutrition.

　Family history: Father had encephalomalacia. An uncle had leukemia.

　History of present illness: Since 1965 after excessive eating and drinking she experienced pain in the epigastrium and back; in 1978 she came for her first consultation because of heart burn accompanying these symptoms. In the stomach x-ray a reflux of barium was observed into the intrahepatic duct from the Lesser curvature of the lower part of the corpus. Also based on a gastroendoscopic examination, the flow of bile fluid into the lesser curvature of the lower part of the corpus was confirmed. When we introduced a cannula into the same area and took photos, we observed the flow of the contrast medium into the duodenum from the ectopic bile duct via the left and right intrahepatic ducts and from the gallbladder via the common hepatic duct. Based on endoscopic retrograde cholangiopancreatography, the morphology of the papilla of Vater was found to be normal and no confluence anomaly of the pancreatic and bile duct was found. Based on laparoscopy there was no finding of inflammation in the region of the liver. In the literature there are reports of 27 cases including our own of duplication of the common bile duct. If we classify them by morphological type, the first type would be septation, the second bifurcation, the third separation and the fourth mixed type. In Europe and America type the second is most common but here in Japan most of cases have been type the third. On the other hand, there were 12 cases of ectopic insertion and its area of distribution ranged anywhere from the cardia of the curvature minor to the pyloric gland region.

　The formation of a duplicated common bile duct and the distribution of the orifice depends on anomalies occurring during the fetal period in the development of the liver, bile ducts, stomach and duodenum. It is an extremely rare disorder. Since we had the chance to observe using x-ray and endoxupy the duplication of the common bile duct having its opening in the lesser curvature of the corpus, we have reported this case here with citations fromthe literature.