膵頭十二指腸切除後のBraun吻合部に発生した多発空腸癌の1例

Synchronized Carcinoma of Braun's Anastomosis After Pancreaticoduodenectomy, Report of a Case

要旨　患者は68歳，女性．貧血，上腹部痛で来院した．既往歴として16年前に十二指腸癌，8年前にS状結腸癌の手術を受けている．上部消化管透視で，Braun吻合部を中心に胆管側，肛門側にまたがった不整で浅い陥凹病変を認め，口側には棍棒状ひだの集中像を認めた．内視鏡検査で切歯から約85cmのBraun吻合部に3型病変を，この病変から2cm口側でひだの集中を伴うⅡc型病変を認め，生検で2病変とも腺癌の結果を得た．摘出標本では，Braun吻合部上に4×3cmの不整形の3型癌を認め，2cm胃側に3mmのⅡc型癌を認めた．組織診断は，深達度は前者がmp，後者はsmで，両病変とも中分化型腺癌であった．組織学的にも2病変に連続性は認められなかった．多発空腸癌がBraun吻合部に発生した症例は，本例以外に欧米文献にも認めなかった．

　A 68-year-old women was admitted with abdominal pain and anemia. She had undergone pancreaticoduodenectomy for duodenal cancer 16 years previously and partial sigmoidectomy for sigmoid cancer eight years before. Upper gastrointestinal barium and gastroscopic examination showed 3 type lesion 50 mm in diameter on the Braun's anastomosis and a Ⅱc type lesion with fold concentration three mm in diameter near the anastomosis. The patient was operated on. Histologically, the lesions were separated and were diagnosed as moderate differentiated adenocarcinoma infiltrating the mp and the sm layer. This is the first reported case in the world of two synchronized jejunal carcinomas occurring at the Braun's anastomosis.