膵管癒合不全に総胆管癌を合併した例と膵癌を合併した例の2症例

Pancreas Divisum Accompanied by Cancer of Common Bile Duct and Pancreas, Report of Two Cases

要旨　われわれは最近，膵管癒合不全に総胆管癌を合併した例と膵癌を合併した例の2症例を経験した．〔症例1〕は84歳男性．黄疸を主訴として来院．ERCPで馬尾状に終わる腹側膵管像と総胆管三管合流部に不整な狭窄を認めた．副乳頭からの造影では背側膵管には異常を認めなかったため，膵管癒合不全に総胆管癌が合併したと診断した．腫瘍は根治的に切除された．〔症例2〕は72歳女性．食欲不振，背部痛，体重減少を訴えて来院．CTで膵体尾部に腫瘤像を認め，ERCPでは樹枝状に短く終わる腹側膵管像が得られたが，副乳頭造影は失敗に終わった．死後剖検により膵管癒合不全に合併した背側膵の癌が確認された．

　Two cases of pancreas divisum accompanied by cancer of common bile duct and pancreas were reported. Patient No. 1 was an 84 year-old man afflicted with jaundice. ERCP showed a short ventral pancreatic duct whose branches were well distributed and an irregular stenosis in the common bile duct near the cystic duct (Fig. 1a). Catheterization of the accessory papilla revealed a normal pancreatic duct (Fig. 1b). Thus, a diagnosis of pancreas divisum accompanied by cancer of the common bile duct was made, and the lesion was cured by surgery (Fig. 2).

　Patient No. 2 was a 72 year-old woman afflicted with anorexia, back pain and weight loss. FRCP showed a short ventral pancreatic duct branching normally (Fig. 3a). CT scan showed a mass in the body and tail of the pancreas (Fig. 3b). But an opacification of dorsal pancreatic duct was not successful. Postmortem resected specimen (Fig. 4) showed pancreas divisum accompanied by cancer originating from the dorsal pancreas.