上腹部痛(Epigastric Pain)シリーズ9 EXPERT COURSE 解答 【症例 EE 45】

総胆管内回虫迷入症.Migration of Ascaris Lumbricoides into common bile duct.








単純CTの図2〜図12の,やや高濃度の線状物(↑)が回虫虫体か? 造影CTでは回虫虫体の認識はさらに困難となる.総胆管内回虫迷入症のCT診断にはDIC(drip-infusion cholangiography:経静脈的胆道造影)/CTが必要である.腹部エコー検査でも診断不可能であった.図Aと図BはMR胆道造影で▲の透亮像が虫体,図CがERCPで△が虫体.バスケット鉗子で摘除を試みた(図D)が成功せず,ステントを挿入した.1週間後の検査で虫体は総胆管から消失していた.検便で回虫卵を認めたため駆虫剤を投与し治癒した.












参考症例(総胆管内回虫迷入症,Plain CT,5mmスライス):48歳女性.上腹部痛と嘔吐のため救急搬送された.図Aの↑が乳頭部に迷入した回虫虫体.CTでは総胆管がやや拡張気味だが,回虫虫体は認識できない.










文献考察1):胆道内回虫迷入.回虫成虫の大きさは幅が3〜6mm,長さは15〜50cm
Korean J Radiol. 2001 Jul-Sep;2(3):175-8.
Biliary ascariasis: MR cholangiography findings in two cases.
Hwang CM, Kim TK, Ha HK, Kim PN, Lee MG.

We describe the imaging features of two cases of biliary ascariasis. Ultrasonography and CT showed no specific abnormal findings, but MR cholangiography clearly demonstrated an intraductal linear filling defect that led to the correct diagnosis. MR cholangiography is thus a useful technique for the diagnosis of biliary ascariasis.PMID: 11752990(full text)

文献考察2):回虫症の外科的合併症.145例中,腸閉塞が最も多く107例(単純閉塞34例,壊死または穿孔48例,捻転18例,腸重積7例),胆道内迷入は19例,虫垂内迷入による虫垂炎10例であった.
World J Surg. 1991 Mar-Apr;15(2):222-7.
Surgical complications of ascariasis.
Ochoa B.

Over the past 25 years (1963-1988), a total of 311 children under 12 years of age were admitted to the Pediatric Surgical Service of the San Vicente de Paul University Hospital, Medellin, Colombia, with complications resulting from infection with Entamoeba histolytica or Ascaris lumbricoides. In this group, the abdominal complications produced by ascariasis numbered 145, and included intestinal obstruction (n = 107), perforation of the appendix (n = 10), and migration of the parasite to the biliary tree or to the peritoneal cavity (n = 28). Evaluation of the living conditions of a significant subgroup of our patients confirms that intestinal parasitism is an endemic condition prevailing in nations that exhibit deep social and economic imbalance, where large sectors of the population remain deprived of the basic services of education, health, housing, and recreation. Massive infestation in children may give rise to grave complications that demand expert surgical care. Third World surgeons practicing in general hospitals that take care of patients of low economic capacity are usually familiar with the diagnosis and management of this pathology; surgeons who practice in the industrialized nations will only occasionally face such problems. The greater mobility of today's societies and the rather massive migrations that take place in current times have resulted in an increasing incidence of these entities in the hospital populations of the large urban centers of these nations. It is for the surgeons practicing in such centers that the information presented herein may be of greater value.PMID: 2031358

文献考察3):胆道内回虫迷入症本邦集計37例
安田一朗,冨田栄一,名倉一夫,他:超音波検査にて診断し内視鏡的に摘出しえた胆管内回虫迷入症のl例.胆と膵 15:703-707,1994.
要旨:回虫症は,最近の無農薬野菜ブーム,海外途上国への旅行者の増加や外国人就労者の増加など社会環境の変化もあるので,現在もなお日常診療において念頭におくべき疾患である.男女比は12:25,年齢は21〜81歳(平均57歳),最近は超音波検査によって診断される症例が増え,内視鏡下に治療されている症例が増えている.

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