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Stomach and Intestine(Tokyo) Volume 7, Issue 11 （November 1972）

胃と腸 7巻11号（1972年11月発行）

Japanese English

今月の主題十二指腸乳頭部病変

主題十二指腸乳頭部病変症例

乳頭部の良性隆起性病変 A Benign Protruded Lesion of the Papilla of Vater: Report of a Case 森井健 ¹ , 竜田正晴 ¹ , 遠藤義彦 ¹ , 奥田茂 ¹ , 谷口春生 ² , 大西明 ³ , 小味淵智雄 ³ T. Morii ¹ , M. Tatsuta ¹ , Y. Endo ¹ , S. Okuda ¹ , H. Taniguchi ² ¹大阪府立成人病センター内科 ²大阪府立成人病センター病理 ³大阪日赤病院内科 ¹Dept. of Internal Med., Center for Adult Diseases ²Dept. of Pathology, Center for Adult Diseases pp.1507-1509

発行日 1972年11月25日 Published Date 1972/11/25

DOI https://doi.org/10.11477/mf.1403109044

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　患　者：S. H.　65歳　女

　病　歴：3年来糖尿病で通院し，Controlは良好であった．約20日前右上腹部に疝痛発作があり，2日前より悪感，発熱と共に黄疸が出現し入院．その後症状は比較的急速に消失し，1年後の現在も経過良行である．

　In the course of choledochitis a nodular tumor of inflammatory origin in the papilla of Vater was seen in a 65-year-old woman. For three years she had ambulatory treatment for diabetes mellitus, which was under good control. About 20 days before she had a bout of colic in the right upper quadrant. She was then hospitalized because icterus appeared beside chill and fever. After admission the symptoms went away fairly repidly. As of one year after operation she has a favorable course.

　Results of examinations showed that directly after admission the liver was palpable one finger and a half's breadth below the costal arch. The right hypochondrium was tender. Blood showed increase of white blood cells. Serum Wassermann's test was positive. Serum bilirubin was 6.3 mg/dl (direct 4.2; indirect: 2.1). SGOT was 54 units with SGPT 75 units. Alkaline phosphatase was 55 KA units, LDH being 330 units, TTT 4 units, Co. R₍₁₎. Serum cholesterol was 242 mg/dl, with CRP positive. Blood glucose level was 110 mg/dl.

　X-ray films of the chest showed an inactive shadow in the lower field of the right lung.

　Roentgenogram of the upper digestive tract disclosed a shadow defect in the second portion of duodenum (Figure 1). Hypotonic duodenography is shown in Figure 2.

　Duodenofiberscopic examination (60 days after the initial pain). Endoscopic pictures (Figures 3 and 4). Histology of biopsied specimen (Figures 6, 7 and 8). Retrograde pancreatocholedochography (Figure 5).