
doi: 10.3919/jjsa.66.935
症例は72歳男性.心窩部痛および黄疸を主訴に当院受診となった.腹部超音波検査および腹部CTにて,膵頭部に多房性の嚢胞性病変,著明な主膵管の拡張と軽度の胆管の拡張を認めた.また, PTCD造影で膵胆管瘻形成が疑われた.総胆管への穿破を伴う粘液高産生性膵管内乳頭粘液性腺癌と診断し,膵頭十二指腸切除術を施行した.病理学的には,微小浸潤を伴う乳頭腺癌が主膵管から分枝膵管まで進展しており,膵胆管瘻周囲には腫瘍細胞を認めなかった.本症例は粘液貯留により引き起こされた嚢胞壁の圧上昇に伴う自潰により瘻孔を形成し,粘液により閉塞性黄疸をきたした,と考えられた.
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