内視鏡的に除去し得た乳頭部の嵌頓結石の1例

Endoscopic Removal of a Gallstone Impacted in the Major Papilla, a Case Report

　総胆管結石が乳頭部に嵌頓すれば，多くは黄疸を発生し，時に膵炎を併発する．乳頭部に嵌頓した結石に対しては，多くは外科的処置によるが，内科的治療により，乳頭に嵌頓した結石の十二指腸への脱落した報告がある．筆者らは近年発達した十二指腸ファイバースコープを用いて，直視下に乳頭部を観察し，乳頭部に嵌頓した結石を生検鉗子を用いて十二指腸内に脱落せしめ得た症例を経験したので報告する．

　A report is made of a case of a choledochus gallstone impacted in the major papilla that has been liberated into the duodenal lumen by means of duodenofiberscope developed in recent times.

　Case: 47-year-old man. At 38, cholecystectomy had been carried out because of gallstones. He was admitted to the hospital on account of severe epigastric pain accompanied with nausea and vomiting. Although not icteric, he had a raise of amylase level in the blood and dilatation of the choledochus as proved by x-ray. Duodenofiberscope revealed a blackish brown gallstone caught in the dilated papilla of Vater, so that the papilla was incised by biopsy forceps incorporated in the fiberscope, resulting in the falling down of the stone into the duodenal lumen.

　Next, we visualized pancreatic duct and choledochus through the entrance of papilla. No stone was demonstrated, although both ducts were enlarged. On the following day, a bilirubin gallstone, measuring 13×8×8 mm, was found in the feces. Blood amylase level had gone down after admission, but it rose slightly after the pancreatic duct had been opacified. There was no complication due to the examination.