内容紹介
Summary
An 80-year-old woman was admitted to our hospital due to jaundice. CT and MRCP revealed that the common bile duct and main pancreatic duct were dilatated due to a cystic lesion in the pancreatic head. Moreover, ERCP revealed the presence of a pancreatobiliary fistula and mucus discharge from the enlarged papilla. The patient underwent biliary and pancreatic drainage using plastic stents. However, the treatment was not effective because of the presence of the protein plug. The patient underwent EST because of her rejection to surgery. After the procedure, jaundice was resolved. We report this case with a review of the available literature.
要旨
症例は80歳,女性。眼球黄染を指摘され当科を受診した。腹部CTとMRCPで総胆管,主膵管の拡張と膵頭部に嚢胞性病変を認めた。また,ERCPにより乳頭部開大と膵管胆管瘻を認め,膵管内乳頭粘液性腫瘍(IPMN)による膵管胆管瘻と診断した。膵管と胆管へステントを留置したが減黄効果は不良であった。しかし患者から手術の同意が得られず,内視鏡的乳頭切開術のみ施行した。黄疸は軽減したが以降の治療は拒否し,自主退院となった。IPMNによる膵管胆管瘻は比較的まれであり報告する。
目次
An 80-year-old woman was admitted to our hospital due to jaundice. CT and MRCP revealed that the common bile duct and main pancreatic duct were dilatated due to a cystic lesion in the pancreatic head. Moreover, ERCP revealed the presence of a pancreatobiliary fistula and mucus discharge from the enlarged papilla. The patient underwent biliary and pancreatic drainage using plastic stents. However, the treatment was not effective because of the presence of the protein plug. The patient underwent EST because of her rejection to surgery. After the procedure, jaundice was resolved. We report this case with a review of the available literature.
要旨
症例は80歳,女性。眼球黄染を指摘され当科を受診した。腹部CTとMRCPで総胆管,主膵管の拡張と膵頭部に嚢胞性病変を認めた。また,ERCPにより乳頭部開大と膵管胆管瘻を認め,膵管内乳頭粘液性腫瘍(IPMN)による膵管胆管瘻と診断した。膵管と胆管へステントを留置したが減黄効果は不良であった。しかし患者から手術の同意が得られず,内視鏡的乳頭切開術のみ施行した。黄疸は軽減したが以降の治療は拒否し,自主退院となった。IPMNによる膵管胆管瘻は比較的まれであり報告する。