6年間の臨床経過とERCPにて明らかな進展のみられたアルコール性膵炎の1例

A Case of Alcoholic Pancreatitis: ERCP revealing its marked advance during clinical observation for six years

症例

　患　者：H. K.　29歳　男性　会社員

　主　訴：心窩部痛および下痢

　家族歴・既往歴：特記すべきものなし

　現病歴：18歳頃より1日5～7合の飲酒歴が11年間にわたってあった．1972年8月20日夕食後，急に心窩部激痛を覚えその後2日間痛みが続き，その上1日に10回以上の下痢をきたすようになったため8月23日に来院した．

　A 29-year-old man drinking heavily for 11 years came to see us on account of pain in the epigastrium. At first the pain was transient, abating within a short time after ambulatory treatment. As he did not give up drinking, he was repeatedly examined by X-ray. The upper GI series showed increasing displacement of the gastric body. Two years later ERCP also showed stricture, rigidity and irregularity of the main pancreatic duct and its branches. A diagnosis of chronic pancreatitis was then made.

　Four years and six months after the initial examination FRCP showed a cyst and a shadow of stones in the tail of the pancreas. This part was then resected. What we had diagnosed as a cyst proved to be an abscess. Tissue of the pancreas in the resected specimen showed entirely far advanced pancreatitis, but exocrine secretory functions as determined by preoperative PS test were only slightly impaired.

　These results led us to evaluate the diagnostic capability of ERCP and the present diagnostic criteria for chronic pancreatitis. Comparison of FRCP findings with exocrine function tests such as PS test seemed to show an discrepancy between well preserved exocrine function tests and far advanced morphological and tissue changes. Diagnosis of chronic pancreatitis by ERCP and its follow-up seem to us of great interest and importance when development and progress of pancreatitis are duly taken into account.