胆汁酸腸石

Bile Acid Enterolith, Report of a Case

　胆汁酸腸石は大変稀で，K. A. H. Mörner²⁰⁾（1908）により報告されて以来，Hellström¹³⁾，Grettve¹²⁾，Atwell²⁾，Bewes⁴⁾らにより欧米で34例報告されているが，本邦での報告は見あたらない．なかでも，一次胆汁酸腸石は，1965年Fisher⁹⁾が胃切除術後輸入脚十二指腸に発生した1例の報告があるのみである．筆者らは，胃切除術後に，一次胆汁酸腸石を生じた症例を経験したので報告する．

　A man 52 years of age, who had undergone gastrectomy 19 years before, began since then to have bouts of diarrhea, nausea and vomiting. In addition, since to years before he noticed in the extremities paresthesia, sense of weakness and muscular atrophy. When first seen, the patient was fairly emacipated. Serum lipids, proteins and iron showed decrease. Screening tests for malabscorption revealed impaired absorption of fat and d-xylose. Diagnosis: afferen loop syndrome associated with malabsorption. Fluoroscopy of the digestive tract showed four persistent filling defects suggestive of stones in theconsiderably dilated jejunal loop.

　At laparotomy, it was found that antecolic gastrojejunostomy with Braun's anastomosis had been performed. The jejunal segment at the site of Braun's anastomosis was dilated like a sack, and four stones 3.0 to 5.2 cm in diameter were palpated therein. The passage between the anastomosed site and the distal jejunum was so constricted that it was barely possible to pass a small finger through it. The dilated jejunal segment containing enteroliths was excised.

　Chemical analysis and thin-layer chromatography of the intestinal stones revealed that approximately 77 per cent of them was of bile acid, which in turn contained 70 to 80 per cent of cholic acid. In addition, there was 10 to 20 per cent of chenodeoxycholic acid, with tiny fractions of deoxycholic acid, free fatty acid and cholesterol.

　Enterolith due to bile acid is of such a rare occurrence that only 34 reports of it have been made abroad. The greatest majority of them concerned with secondary bile acid enterolith, while that consisting mostly of primary bile acid as seen by us was reported only by Fischer in 1965. In our country this is the first report of bile acid enterolith.