慢性閉塞性膵炎を伴ったintraluminal duodenal diverticulumの1例

• Published in: 日本消化器外科学会雑誌 Vol. 35; no. 10; pp. 1620 - 1624
• Main Authors: 尾形 章, 大野 一英, 升田 吉雄, 遠藤 文夫, 新井 竜夫, 増田 益功, 笹田 和裕
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人日本消化器外科学会 01.10.2002; The Japanese Society of Gastroenterological Surgery
• Subjects: chronic obstructive pancreatitis; intraluminal duodenal diverticulum
• ISSN: 0386-9768

症例は18歳の女性.突然の嘔気と上腹部痛を訴えた他院受診し膵炎およびintraluminal duodenal diverticulum(IDD)の診断にて当科紹介,入院となった.上部消化管造影にて十二指腸第2部腔内に約2mmの薄い嚢状の透亮像を認め,MRCPでは腹側膵および背側膵の癒合部位に狭窄と上流膵管の拡張を認めた.1997年8月25日IDDおよび慢性閉塞性膵炎の診断にて十二指腸腔内憩室切除およびRoux-Y吻合による膵管空腸吻合を施行した.IDDに伴う膵炎の報告例は18例認められ,治療として開腹或いは内視鏡的な憩室切除にてIDDおよび膵炎の症状改善がなされている.しかし,自験例のごとき部位の膵管狭窄例は膵液のドレナージを要し膵管空腸吻合を必要とした.腹側膵および背側膵癒合部の狭窄は先天性異常に起因することがほとんどであるとの報告もあり自験例ではIDDおよび膵管不完全癒合の併存の可能性が強く示唆された. An 18-year-old woman with intraluminal duodenal diverticulum (JDD) and chronic obstructive pancreatitis suffered occasional nausea and had a 6-year history of episodes of increasingly upper abdominal pain. Upper gastrointestinal radiography showed a pocket-like lesion extending caudally in the second portion of the duodenum. Magnetic resonance cholangiopancreatography revealed stricture of the main pancreatic duct at the pancreatic head and upstream dilation. A preoperative diagnosis of IDD and chronic obstructive pancreatitis was made, necessitating excision of the IDD at duodenotomy and a Roux-Y lateral pancreaticojejunostomy. Symptoms completely disappeared and pancreatic exocrine function recovered to within normal ranges. In the literature, 18 cases of pancreatitis combined with IDD have been reported thus far and most were treated with excision of the IDD surgically or endoscopically. In our case, pancreaticojejunostomy was needed to eliminate pancreatitis, because stricture of the pancreatic duct was present at the fusion of forsal and ventral pancreatic ducts. Such strictures have been reported mostly associated with congenital anomalies. We concluded that chronic obstructive pancreatitis with IDD was caused by incomplete fusion of the pancreatic ducts.