간내담관을 침범한 간세포암에서 발생한 혈액담즙증 1예 = A Case of Hepatocellular Carcinoma Invading Intrahepatic Duct Complicated by Hemobilia

다국어 초록 (Multilingual Abstract)

A seventyone-year-old male presented with sudden epigastric pain followed by jaundice and intermittent right upper abdominal pain. He was diagnosed as hepatocellular carcinoma 7 years ago, and has been treated with transarterial chemoembolization, percuaneous ethanol injection and segmentectomy. On admission, the level of serum bilirubin, amylase and lipase were 8.7 mg/dL, 560 IU/L, and 13,297 IU/L, respectively. Stool occult blood test was positive. Abdominal computed tomography revealed newly- appeared intraductal soft tissue mass with ductal dilatation. Endoscopic retrograde cholangiography demonstrated filling defects in the common hepatic and distal common bile duct (CBD). Endoscopic sphincterotomy was performed and the clots in the distal CBD were removed. An intraductal stent was inserted at the common hepatic duct. The obstructive jaundice and pancreatitis were resolved. Our case suggests that intraductal hepatocellular carcinoma may induce hemobilia as a possible cause of acute pancreatitis

국문 초록 (Abstract)

71세 남자 환자가 황달과 우상복부 통증에 이은 갑작스러운 심와부의 동통으로 내원하였다. 환자는 7년 전 간세포암으로 진단 받은 후 경동맥 화학 색전술 및 경피적 에탄올 주입술과 종양 절제술을 시행받았다. 내원 당시 말초혈액 검사에서 총 빌리루빈은 8.7 mg/dL, 혈청 아밀라제와 리파아제는 각각 560 IU/L와 13,297 IU/L였고, 대변잠혈검사는 양성이었다. 복부 전산화 단층 촬영에서 이전에 보이지 않던 담관 확장 및 담도 내의 연부조직 음영이 관찰되었고, 내시경적 역행성 담도췌관 조영술에서 총간담관과 원위부 총담관에서의 충만결손이 관찰되었다. 내시경적 유두괄약근절개술 후, 총담관의 혈병을 제거하였고, 총간담관의 종괴에 대해서는 스텐트를 삽입하였으며, 경비담관배액술을 시행하였다. 이후 환자의 폐쇄성 황달 및 급성 췌장염의 증상이 호전되었다. 저자들은 간세포암 환자에서 혈액담즙증이 발생할 수 있고, 혈액담즙증은 급성 췌장염을 야기할 수 있는 잠재적인 원인이 될 수 있기에 이를 문헌 고찰과 함께 보고하는 바이다.

참고문헌 (Reference)

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