総胆管囊腫に総胆管癌を併発した1症例

A Case of Carcinoma in Congenital Choledochal Cyst

　総胆管囊腫の症例は稀ならず発見されるが，本症に胆管癌が合併した症例の報告はきわめて少ない．最近われわれは十二指腸ファイバースコープおよび逆行性胆管造影により，総胆管囊腫に胆管癌を合併した興味ある症例を診断しえたので，若干の考察を加えてここに報告する．

　This report is concerned with a case of congenital choledochal cyst complicated by the occurrence of cancer six years after cystoduodenal anastomosis which was diagnosed by duodenofiberscopy and endoscopic retrograde cholangiography.

　Symptoms were characterized by general malaise, weight loss and recurrent attacks of colicky pain in the epigastrium, anorexia, and fever which were relieved only transiently by medical treatment.

　Pneumobilia was noted on a plain film of the abdomen. Intravenous cholantiography failed to reveal the biliary tract. Endoscopic observation revealed irregularity and hemorrhage on the margin of the orifice of the choledochal cyst-duodenal anastomosis.

　Endoscopic retrograde cholangiography showed a cystic dilatation of the common bile duct with a stenosis in the most distal segment and multiple irregular shadow defect in the common bile duct. Biopsy obtained from the cyst disclosed papillary adenocarcinoma.

　This case belongs to the type I, congenital cystic dilatation of the common duct, according to the clas-sification made by Alonso-Lej (1959).

　Operative findings: The common bile duct was buried in the surrounding tissue invaded by the malignat lesion forming a large mass.

　Resection of the malignant lesion could not be performed. Kasai et al. reported a review on 15 cases of choledochal cyst complicated by the occurence of cancer. It was disclosed that in 5 of these 15 cases cystointestinal anastomosis had been performed before the presence of the malignant lesion was diagnosed.

　These 5 cases and our experience indicate that resection of the cyst should be preferably performed for the surgical treatment of the choledochal cyst.