총담관-십이지장 누공을 동반한 담관 내 점액성 유두 종양

Abstract

담관 내 점액성 유두 종양이 다른 장기와 누공을 형성한 증례보고는 저자들이 문헌고찰한 것에 의하면 없으며, 누공형성 기전도 확립된 것이 없어 더 많은 보고와 연구가 필요하다. 저자들은 황달과 가려움증으로 내원하여 총담관-십이지장 누공을 동반한 담관 내 점액성 유두 종양을 진단하였으며, 간좌엽 절제술 및 담낭절제술로 치료한 증례를 경험하여 보고한다.An intraductal papillary mucinous neoplasm of the bile ducts (IPMN-B) is an uncommon tumor characterized by the secretion of large amounts of mucin and intraductal growth. The characteristic clinical symptoms and radiologic findings are due to bile-duct obstruction caused by mucin. A parapapillary choledochoduodenal fistula is a rare disorder. This fistula has no clinical symptoms and is diagnosed by chance. We report a case of parapapillary choledochoduodenal fistula associated with IPMN-B. A 63-year-old woman was admitted to Hanyang University Hospital because of jaundice. Computed tomography (CT) showed diffuse intra- and extrahepatic bile duct dilatation. The ducts were filled with heterogenous material. Duodenoscopy revealed a large choledochoduodenal fistula. Endoscopic retrograde cholangiography through the fistula showed a papillary mass in the common hepatic duct. IPMN-B with choledochoduodenal fistula was diagnosed. The patient underwent a left hepatectomy. Her postoperative course was uneventful, and she was observed regularly in the outpatient department. (Korean J Med 2011;81:93-97)