title: [A patient with middle bile duct cancer who showed rapid obstruction on contrast radiographs 1 week after insertion of a non-covered stent, but this case obtained a long-term stent opening and long survival after re-insertion of a covered stent].
abstract: A 73-year-old female with jaundice was referred to our department and admitted. Blood examination on admission showed an abnormal liver function and an increase in CA19-9. Ultrasonography of the abdomen revealed a well-delineated round mass in the middle bile duct. After admission, PTBD was performed, and a complete obstruction was observed in the middle bile duct. Cytological examination of the bile demonstrated adenocarcinoma. Based on these findings, a diagnosis of middle bile duct cancer was made. Because of delirium and frequent wandering during the night due to dementia, a radical operation was abandoned, and a non-covered stent was placed. However, since 1 week after insertion of a non-covered stent, contrast radiography showed tumor protrusion (rapid obstruction) in the stent, and a covered stent was placed in the stent. The stent was open for 486 days after stent re-insertion. PTBD was performed for re-obstruction, but she died 596 days after admission. In patients for whom surgery is impossible for reasons other than tumor factors, internal fistula construction using a metallic stent, which neither impairs QOL nor shorten survival, can be indicated.
authors.affiliation: Dept. of Surgery, Kurume University School of Medicine.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Hidaka
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kawahara
authors.forename: Katsuji
authors.initials: K
authors.lastname: Yanagi
authors.forename: Takenori
authors.initials: T
authors.lastname: Sakai
authors.forename: Shinji
authors.initials: S
authors.lastname: Uchida
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Horiuchi
authors.forename: Masao
authors.initials: M
authors.lastname: Hara
authors.forename: Hisafumi
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Aoyagi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shirouzu
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002779:Cholestasis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D004867:Equipment Design; D006801:Humans; D008297:Male; D011859:Radiography; D015607:Stents