巨大十二指腸憩室内の食物残渣が原因で発症したLemmel症候群の1例

[A case of Lemmel syndrome caused by food residue in giant juxtapapillary diverticulum].

• Kazuko Shinagawa
• Kazuhiko Okada
• Tomotaka Yokota
• Akira Ueda
• Yoshiharu Tokimitsu
• Akio Entani
• Ichirou Yasuda

抄録

70歳代の女性が下腹部痛と食欲不振を訴えて当院に入院した．臨床検査では肝トランスアミナーゼ，胆道酵素，アミラーゼが高値を示した．CTとMRCPで胆管と膵管の拡張と内容物で満たされた大きな十二指腸憩室を認めた．胆石や腫瘍はなかった。鑑別診断ではVater乳頭閉塞と診断されたため，緊急にERCPを行った．内視鏡検査では食物残渣で満たされた十二指腸憩室が確認されたが、Vater乳頭の位置は不明であった。胆石に使用されているリトリーブバルーンカテーテルを用いて憩室内の食物残渣を洗浄除去した。内視鏡的に食物残渣を除去したところ、患者さんの下腹部痛はすぐに治まり、胆管炎、膵炎も徐々に改善していった。

A woman in her 70s was admitted to our hospital because of epigastric pain and anorexia. Laboratory evaluations revealed elevated levels of liver transaminases, biliary enzymes, and amylase. CT and MRCP showed dilatation of the bile and pancreatic ducts and a large juxtapapillary diverticulum filled with contents. There were no gallstones or tumors present. Our differential diagnosis included obstruction of the papilla of Vater, so we performed an urgent ERCP. Endoscopic examination showed the juxtapapillary diverticulum filled with food residue;however, we were unable to locate the papilla of Vater. We rinsed out and removed food residue from the diverticulum using a retrieval balloon catheter used for gallstones. After the endoscopic removal of the food residue, the patient's epigastric pain immediately subsided and her cholangitis and pancreatitis improved gradually.