胆石様疝痛発作を主訴として発見された早期下部胆管癌の1例

Early Cancer of the Distal Bile Duct, Report of a Case

　近年，腹部超音波検査，CT，PTC，ERCPなどの普及により，早期胆管癌の報告例が増えてきている．今回われわれは，胆石様疝痛発作を主訴として来院し総胆管結石との診断のもとに開腹したが，切除標本では1.5×1.5×2.0cmの早期乳頭状腺癌が見出された1例を経験したので報告する．

　A 79 year-old woman patient was hospitalized with epigastric pain. Ultrasonic examination showed dilatation of the common bile duct. Percutaneous transhepatic cholangiography (PTC) showed marked dilatation of intrahepatic ducts and a stone-like shadow about 2.0 cm in diameter in the common bile duct. A few days later, because of marked stenosis of the common bile duct, PTC drainage was performed. As a result, a reversed U sign was seen in the common bile duct. Our preoperative diagnosis was a stone in the common bile duct. But, during the operation, we found a polypoid lesion in the common bile duct. Therefore, pancreatoduodenectomy was performed. Histologically diagnosis was papillary adenocarcinoma. About ten months have passed since the surgical operation, and the patient is in good health with no sign of recurrence.