胆管内乳头状粘液瘤伴胆总管十二指肠瘘:病例报告和文献综述。

IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL
AME Case Reports Pub Date : 2024-07-18 eCollection Date: 2024-01-01 DOI:10.21037/acr-24-54
Cong Ding, Jian-Feng Yang, Bin Yang, Xia Wang, Xiao-Feng Zhang
{"title":"胆管内乳头状粘液瘤伴胆总管十二指肠瘘:病例报告和文献综述。","authors":"Cong Ding, Jian-Feng Yang, Bin Yang, Xia Wang, Xiao-Feng Zhang","doi":"10.21037/acr-24-54","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is a neoplastic disease of the bile duct with papillary hyperplasia and mucus secretion, which originates from the duct epithelium and rarely complicates with fistula formation.</p><p><strong>Case description: </strong>The patient was admitted to the hospital due to abdominal pain and yellow skin. Laboratory results showed alanine aminotransferase 299 U/L, total bilirubin 350 µmol/L, computerized tomography showed severe dilatation of common bile duct and extrahepatic bile duct. Magnetic resonance cholangiopancreatography showed the intra- and extrahepatic bile ducts were markedly dilated, and the signal of the bile ducts was uneven. Endoscope identified a large amount of mucus above the papilla that flowing out from the fistula. Further cholangiography through the fistula showed significant dilatation of the extrahepatic bile duct. SpyGlass examination showed a large amount of gelatinous mucus in the bile duct lumen and \"fish-scaly or coral\" changes in the mucosa of the right anterior branch bile duct, hepatic hilum as well as lower common bile duct. IPMN-B with choledochoduodenal fistula was diagnosed. The patient was then discharged with nasal biliary drainage and biliary stenting, oral antipyretic and hepatoprotective drugs. The patient's biliary obstruction and symptoms of infection improved with medical treatment but recured. Unfortunately, the patient died 10 months after his first visit.</p><p><strong>Conclusions: </strong>SpyGlass has advantages in identifying the nature and extent of lesions, providing important references for diagnosis and treatment. Endoscopic intervention relieves biliary obstruction to some extent in patients with high operative risk or reluctance to undergo surgery.</p>","PeriodicalId":29752,"journal":{"name":"AME Case Reports","volume":"8 ","pages":"86"},"PeriodicalIF":0.7000,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459443/pdf/","citationCount":"0","resultStr":"{\"title\":\"Intraductal papillary mucinous neoplasm of the bile duct with choledochoduodenal fistula: a case report and literature review.\",\"authors\":\"Cong Ding, Jian-Feng Yang, Bin Yang, Xia Wang, Xiao-Feng Zhang\",\"doi\":\"10.21037/acr-24-54\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is a neoplastic disease of the bile duct with papillary hyperplasia and mucus secretion, which originates from the duct epithelium and rarely complicates with fistula formation.</p><p><strong>Case description: </strong>The patient was admitted to the hospital due to abdominal pain and yellow skin. Laboratory results showed alanine aminotransferase 299 U/L, total bilirubin 350 µmol/L, computerized tomography showed severe dilatation of common bile duct and extrahepatic bile duct. Magnetic resonance cholangiopancreatography showed the intra- and extrahepatic bile ducts were markedly dilated, and the signal of the bile ducts was uneven. Endoscope identified a large amount of mucus above the papilla that flowing out from the fistula. Further cholangiography through the fistula showed significant dilatation of the extrahepatic bile duct. SpyGlass examination showed a large amount of gelatinous mucus in the bile duct lumen and \\\"fish-scaly or coral\\\" changes in the mucosa of the right anterior branch bile duct, hepatic hilum as well as lower common bile duct. IPMN-B with choledochoduodenal fistula was diagnosed. The patient was then discharged with nasal biliary drainage and biliary stenting, oral antipyretic and hepatoprotective drugs. The patient's biliary obstruction and symptoms of infection improved with medical treatment but recured. Unfortunately, the patient died 10 months after his first visit.</p><p><strong>Conclusions: </strong>SpyGlass has advantages in identifying the nature and extent of lesions, providing important references for diagnosis and treatment. Endoscopic intervention relieves biliary obstruction to some extent in patients with high operative risk or reluctance to undergo surgery.</p>\",\"PeriodicalId\":29752,\"journal\":{\"name\":\"AME Case Reports\",\"volume\":\"8 \",\"pages\":\"86\"},\"PeriodicalIF\":0.7000,\"publicationDate\":\"2024-07-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459443/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"AME Case Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.21037/acr-24-54\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"AME Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.21037/acr-24-54","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

摘要

背景:胆管导管内乳头状黏液瘤(IPMN-B)是一种胆管肿瘤性疾病,伴有乳头状增生和黏液分泌,起源于胆管上皮,很少并发瘘管形成:患者因腹痛和皮肤发黄入院。化验结果显示丙氨酸氨基转移酶 299 U/L,总胆红素 350 µmol/L,计算机断层扫描显示胆总管和肝外胆管严重扩张。磁共振胰胆管造影显示肝内和肝外胆管明显扩张,胆管信号不均匀。内窥镜发现乳头上方有大量粘液从瘘管流出。通过瘘管进行的进一步胆管造影显示肝外胆管明显扩张。窥镜检查显示胆管腔内有大量胶状粘液,右前支胆管、肝门和下胆总管粘膜有 "鱼鳞状或珊瑚状 "改变。诊断结果为伴有胆总管十二指肠瘘的 IPMN-B。随后,患者经鼻胆道引流术和胆道支架植入术,口服退热药和保肝药后出院。经药物治疗后,患者的胆道梗阻和感染症状有所改善,但又复发了。不幸的是,患者在首次就诊 10 个月后去世:SpyGlass 在确定病变性质和范围方面具有优势,为诊断和治疗提供了重要参考。对于手术风险较高或不愿接受手术的患者,内镜干预可在一定程度上缓解胆道梗阻。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intraductal papillary mucinous neoplasm of the bile duct with choledochoduodenal fistula: a case report and literature review.

Background: Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is a neoplastic disease of the bile duct with papillary hyperplasia and mucus secretion, which originates from the duct epithelium and rarely complicates with fistula formation.

Case description: The patient was admitted to the hospital due to abdominal pain and yellow skin. Laboratory results showed alanine aminotransferase 299 U/L, total bilirubin 350 µmol/L, computerized tomography showed severe dilatation of common bile duct and extrahepatic bile duct. Magnetic resonance cholangiopancreatography showed the intra- and extrahepatic bile ducts were markedly dilated, and the signal of the bile ducts was uneven. Endoscope identified a large amount of mucus above the papilla that flowing out from the fistula. Further cholangiography through the fistula showed significant dilatation of the extrahepatic bile duct. SpyGlass examination showed a large amount of gelatinous mucus in the bile duct lumen and "fish-scaly or coral" changes in the mucosa of the right anterior branch bile duct, hepatic hilum as well as lower common bile duct. IPMN-B with choledochoduodenal fistula was diagnosed. The patient was then discharged with nasal biliary drainage and biliary stenting, oral antipyretic and hepatoprotective drugs. The patient's biliary obstruction and symptoms of infection improved with medical treatment but recured. Unfortunately, the patient died 10 months after his first visit.

Conclusions: SpyGlass has advantages in identifying the nature and extent of lesions, providing important references for diagnosis and treatment. Endoscopic intervention relieves biliary obstruction to some extent in patients with high operative risk or reluctance to undergo surgery.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信