간내 결석에 동반된 담관 방선균증 1예
Actinomycosis of the intrahepatic bile duct concomitant with intrahepatic duct stones
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초록
방선균증은 만성 화농성 육아종성질환으로 임상증상 및 영상학적 소견이 비특이적이어서 진단에 어려움이 있는 질환이다. 저자 등은 임상적으로 방선균증을 의심하지 않았던 50세 여자 환자에서 총담관 결석 및 간내 결석에 동반되어 간절제수술 후 조직학적으로 확인된 방선균증을 경험하였기에 문헌고찰과 함께 보고하는 바이다.
Abstract
Actinomycosis is a chronic, suppurative, granulomatous disease caused by Actinomyces species, a filamentous, Gram-positive anaerobic bacterium and a normal inhabitant of the oral cavity and gastrointestinal tract characterized by sulfur granule formation. Primary bile duct actinomycosis is very rare in Korea and the pathogenesis of this infection is poorly understood. We report a case of actinomycosis of the intrahepatic bile duct, concomitant with common bile duct and intrahepatic duct stones presenting as intermittent right upper quadrant abdominal pain without fever as the chief complaint in a 50-year-old woman. The radiologic findings revealed multiple intrahepatic duct and common bile duct stones. On performing a left lobectomy of the liver and endoscopic retrograde cholangiopancreatography, marked dilatation of the intrahepatic bile duct and many brown pigment stones in the intrahepatic duct and common bile duct were observed. Primary bile duct actinomycosis was confirmed by identifying sulfur granules with neutrophilic infiltration in the intrahepatic duct.
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