A Surgical Case of Obstructive Jaundice Occurring Subsequently to a Scar of Duodenal Post-Bulbar Ulcer

Akiyo Matsumoto, Susumu Nobusawa, Taihei Aoi, Fumio Aoki, Kazuki Yamazaki, Shingo Shikano, Teruo Katayanagi, Isao Kudo*, Masamitsu Shoji**

Department of Surgery, Yuai Memorial Hospital
*Division of Radiological Diagnosis, Yuai Memorial Hospital
**Division of Pathology, Yuai Memorial Hospital

A 72-year-old man who underwent surgery for a perforated duodenal ulcer 13 years earlier was admitted to our hospital with a main complaint of jaundice. While this patient manifested the pentalogy of Reynolds over a period of about 2 hours, emergency percutaneous transhepatic biliary drainage saved his life. After that, a linear scar of the duodenal ulcer and stenosis with a 5-mm internal diameter were detected in the superior duodenal angle by gastroscopy and hypotonic duodenography. On abdominal CT scanning, the head of the pancreas was found to be swollen, and the pancreatic duct was dilated from the head to the tail through the body. On angiography, a non-vascular lesion was seen in the head of the pancreas, and the artery distributing blood to this region showed smooth narrowing. On percutaneous transhepatic cholangiography, a sleeve obstruction with an irregular margin was observed in the center of the bile duct running in the pancreas. Based on these findings, we made the diagnosis of carcinoma of the head of the pancreas, and undertook pancreatoduodenectomy. The duodenal papilla could not be identified macroscopically because of the linear ulcer scar. Because growth of nerves and glands, but not tumorous lesions were histologically observed in the wall of the common bile duct, his obstructive jaundice was thought not to have been caused by carcinoma. It was very interesting that obstructive jaundice in this patient seemed to be caused by the scar of the duodenal ulcer.

Key words
post bulbar ulcer, obstructive jaundice

Reprint requests
Akiyo Matsumoto The Department of Surgery, Yuai Memorial Hospital
726 Sekido, Sowa-cho, Sashima-gun, Ibaragi, 306 JAPAN

Accepted
October 9, 1991

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