담관기형으로 예방적 담낭절제술 시행받은 특이한 과거력 - 동대문구 답십리, 이문동, 우리안애 우리안愛 내과

혈압약 투약하였으나 갈팡질팡의 모습, 이차고혈.. : 네이버블로그 (naver.com)

상기 환자 과거력중

담낭 절제술받았다고 하는데 이유는 담관기형이 있어서

가족력중 언니가 담낭암

Ultrasound

It has a limited role in diagnosis, but is a useful noninvasive tool for screening. Careful measurement of the common bile duct and comparison with the normal limits for age helps in early detection. Detection of a dilated common bile duct may be the first clue to suspect pancreaticobiliary maljunction with biliary dilatation. In this case, further MRCP is recommended for biliary junction anatomy. It is also associated with gallbladder wall thickening. However, it is non-specific. 초음파의 역할은 제한적이나.. 총담관의 확장을 측정할 수 있다.

The visualization of pancreaticobiliary junction outside the duodenal wall can be detected at endoscopic ultrasound. It is also helpful in screening and surveillance of biliary cancer after diagnosis of pancreaticobiliary maljunction.

CT/MRI

• pancreaticobiliary junction outside the duodenal wall

• common channel length of ≥8 mm, though some authors suggest a cutoff of >15 mm

• an abnormal union between the pancreatic and bile ducts

• common bile duct dilatation is suggestive of pancreaticobiliary maljunction with biliary dilatation

MRCP is the gold standard of diagnosis and is superior to ERCP in depicting biliary anatomy, including the intrahepatic bile duct.

Drip-infusion cholangiography CT involves the injection of intravenous biliary contrast agent and can well-delineate biliary anatomy and is less invasive than ERCP.

Treatment and prognosis

Once an anomalous pancreaticobiliary junction has been diagnosed, risk-reducing prophylactic surgical correction is recommended to reduce the risk of developing biliary cancer. Follow up of these cases is essential even years after prophylactic surgery as the residual bile ducts still have risk for cancer.

For patients without biliary dilatation, prophylactic cholecystectomy is recommended as the gallbladder is the commonest site for cancer development in these patients. 총담관 확장이 없는 경우 예방적 담낭절제술, 담낭이 이 경우에 가장 흔한 악성종양의 발생 위치이기 때문이다.

Anomalous pancreaticobiliary junction | Radiology Reference Article | Radiopaedia.org

Treatment of Pancreaticobiliary Maljunction

The treatment of choice for PBM with biliary dilatation is prophylactic flow-diversion surgery (bile duct resection and bilioenteric anastomosis) before malignant changes can take place in the biliary tract. Internal drainage operation is often performed because of high risk of carcinogenesis after operation. 총담관이 확장되어 있으면 악성변화가 있기전에 담관 유로 우회 수술을 받아야 한다.

On the other hand, treatment of PBM without biliary dilatation or cancer is controversial. Prophylactic cholecystectomy is alone performed in many institutions, as most biliary cancers that develop in PBM patients without biliary dilatation are gallbladder cancers. However, some surgeons suggest that the extrahepatic bile duct together with gallbladder should both be excised in PBM patients without biliary dilatation because of a perceived risk of bile duct cancer.

Pancreaticobiliary Maljunction - Clinical Gastroenterology and Hepatology (cghjournal.org)

총담관의 확장이 없다면 일차진료기관에서 의심하거나 확인하기는 어려울 것으로 보인다.

​동대문구 답십리 우리안애, 우리안愛 내과, 건강검진 클리닉 내과 전문의 전병연

#동대문구내과 #성동구내과 #광진구내과 #답십리역 #장안평역 #용답역 #청량리역 #신답역 #한양대역 #왕십리역 #답십리사거리 #촬영소사거리 #전농동사거리 #내과 #국가검진 #위내시경 #대장내시경 #갑상선초음파 #복부초음파 #경동맥초음파 #심장초음파 #암검진 #래미안위브아파트 #엘림스퀘어 #두산아파트 #동아아파트 #한양아파트 #동답한신아파트 #두산위브아파트 #힐스테이트청계아파트 #래미안미드카운티 #청솔우성 #래미안크레시티 #롯데캐슬노블레스