Meinvörp í stunguörum eftir gallkögun : sjúklingur með óvænt hulið briskrabbamein

Abstract

A 63 year old patient underwent uneventful laparoscopic cholecystectomy in 1994. The patient had a long history of biliary colic after fatty meals. The chief presenting symptom was pain localized in the epigastrium radiating to the back and later distributing to the whole abdomen. The patient also had a history of constipation, but no other symptoms were noted. An ultrasonogram of the liver, gall bladder and pancreas was reported to show calculi in the gall bladder but otherwise normal findings. The laparascopic cholecystectomy was uneventful with discharge the following day. The symptoms however did not disappear, changing in character, locating at the center of the abdomen. The patient began to lose appetite with bouts of diarrhea. The symptoms gradually increased and the patient was admitted to the hospital. Upon arrival the patient was found to have diffuse abdominal pain with a painful swelling of the umbilical trocar site. Incarcerated hernia was suspected, but proved to be a mass at exploration. Pathologic examination disclosed a metastatic adenocarcinoma. A similar but smaller mass was also discovered in the epigastric trocar site. CT scan showed a pancreatic carcinoma of the corpus with infiltration. The patient deteriorated rapidly and died four months after the diagnosis of pancreatic cancer.

Árið 1994 var framkvæmd gallkögun á 63 ára gömlum sjúklingi vegna gallkveisu, aðgerðin gekk vel fyrir sig. Ómskoðun sem hafði verið framkvæmd fyrir aðgerð sýndi einungis gallsteina. Eftir aðgerð héldu verkir áfram en voru nú aðallega í miðjum kviði. Einum mánuði eftir aðgerð var sjúklingur lagður inn brátt vegna verkja um allt kviðarhol og auma fyrirferð í naflaörinu. Vegna gruns um innklemmt naflakviðslit var sjúklingur tekinn til aðgerðar. Fyrirferð var skorin burt og reyndist vera meinvarp frá kirtilkrabbameini. Svipuð fyrirferð fannst í öðru stunguöri. Tölvusneiðmynd sýndi krabbamein í brisi. Einkenni sjúklings versnuðu mjög hratt og lést hann fjórum mánuðum síðar. Fylgikvillar koma í stunguör eftir kaganir eins og önnur ör. Ymsar tilgátur eru uppi um orsakir þessara meinvarpa. Meinvörpum í stunguörum eftir gallkögum hefur ekki verið lýst í þremur stórum uppgjörum á gallkögunum. Þetta virðist því vera sjaldgæf hliðarverkun en þó hefur nokkrum tilfellum verið lýst.