十二指腸乳頭部癌に伴う傍乳頭総胆管十二指腸瘻

Parapapillary Choledochoduodenal Fistula Associated with Carcinoma of the Papilla of Vater

　近年，内視鏡的逆行性膵・胆管造影法（ERCP）の普及と共に，従来まれとされていた傍乳頭総胆管十二指腸瘻が比較的多く発見されるようになってきた^1)～3)．本症における瘻孔は，その大部分が胆管結石の自然脱落に関係して形成されると考えられているが，筆者らは十二指腸乳頭部癌に関連した本症の4例を経験し，若干の興味ある知見を得たので報告する．

　Parapapillary choledochoduodenal fistula has been drawing increasing attention with recent advance in endoscopic retrograde cholangiopancreatography. Almost all patients hitherto reported had gallstones at diagnosis or by history, and their fistulas were considered to have been caused by spontaneous extrusion of a common bile duct stone. We have described four patients with this entity associated with carcinoma of the papilla, not with cholelithiasis. Two of these patients had jaundice, which was marked but suddenly disappeared in one and was slight and subsided further in the other. The remaining two patients showed no jaundice. Disappearance or absence of jaundice in the four patients seemed to be related to the presence of parapapillary choledochoduodenal fistula formed by direct penetration of the carcinoma (cases 2～4) or, possibly by piercing bile duct pressure posed on a weakness due to submucosal invasion of malignant cells (case 1).