대한소화기내시경학회 증례 집담회 대구가톨릭대학병원 내과 조규현.

Presentation on theme: "대한소화기내시경학회 증례 집담회 대구가톨릭대학병원 내과 조규현."— Presentation transcript:

1 대한소화기내시경학회 증례 집담회 대구가톨릭대학병원 내과 조규현

2 Male, 72 yr Chief Complaint : epigastric pain for 1 day
Present Illness 내원 2개월 전부터 간헐적으로 상복부 통증 있었으나 검사 없이 지내던 중 내원 당일 sudden onset colicky epigastric pain 생겨 개인의원 방문 실시한 복부초음파 검사에서 dilatation of IHD & CBD 진단 및 치료 위해 본원으로 전원

3 Past History Physical Examination fever/chill (-/-)
: 20년 전 appendicitis with panperitonitis로 operation Hx. (+) Physical Examination Sclera: anicteric Abdomen: mild tenderness (+) on epigastric area

4 Laboratory Findings CBC: 11,300-12.6-251,000 AST/ALT 373/160 U/L
ALP 543 U/L, rGTP 256 U/L, LDH 1350 T-Bil 1.1 mg/dL, albumin 4.2 g/dL HBs Ag/Ab —/— Amylase/Lipase 46/37 U/L BUN/Cr 12.0/0.8 mg% AFP 2.11, CA , CEA 0.77

5 외부 CT

6 3rd day 2’ Adm.

7 7th day

8 8th day

9 9th day

10 Tentative diagnoses Dilated CBD (with intraductal material) cause?
r/o Ampullary tumor con: no mass on EUS r/o passed stone or passed sludge pro: IHD stone, CBD-IHD matarial r/o intraductal papillary neoplasm, CHD & IHD IHD stone, right lobe, S6

11 1st day 2’ Adm.

12 2nd day

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22 3rd day

23 Adenoma with severe dysplasia
3’ Adm. RASD Adenoma with severe dysplasia RPSD Distal CBD

24 Treatment : Rt. hemihepatectomy with Roux-en-Y HJstomy

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26 Final Diagnosis Intraductal papillary adenoma with adenocarcinoma, RPSD and RHD = intraductal papillary mucinous tumor of bile duct(IPMT) - Stage I: TisN0M0  Rt. hemihepatectomy with Roux-en-Y HJ-stomy IHD stone, S6