case 5 内視鏡的膵・胆管造影で診断しえた特発性総胆管拡張症

Idiopathic Dilatation of the Common Bile Duct, a Case Report

患　者：51歳の主婦

主　訴：右上腹部痛，および微熱．家族歴，および既往歴に特記すべきことなし．

現病歴：昭和46年7月頃より食思不振を自覚し，8月頃一過性の黄疸を経験し，その後発汗を伴う悪感があり，微熱が続くようになった．12月7日本科受診．

　Case: a 51-year-old woman.

　Chief complaint: pain in the right upper quadrant of the abdomen accompanied with slight rise in temperature.

　Familial and past histories: non-contributory.

　Present history: Since July 1971 she noticed loss of appetite. In the following month she had a bout of jaundice, followed by chills with subsequent perspiration. Slight fever persisted thereafter. She visited our Department on Dec. 7.

　Status presens at the initial examination: The patient is of middle stature and well nourished. No icterus on the conjunctivae. Neither the liver nor spleen palpable. Tenderness on the gallbladder points including those of John, Onodera, Sawada's G and Osame.

　General examination revealed only a mild anemia. Study of the blood chemistry showed slight increase of total bilirubin of 1.1 units with direct bilirubin 0.4 units. Otherwise all were within normal limits.

　As are shown in the illustrations, endoscopic cholangiography has enabled us to arrive at a diagnosis of cholecystitis following idiopathic dilatation of the common bile duct. Operation was accordingly done. In the course of endoscopic cholangiography about 60 ml of pure bile was obtained, from which pseudomonas was cultured.