村田 一素¹, 我山 秀孝¹, 清水 敦哉¹, 竹内 謙二², 国吉 幹夫¹, 為田 靭彦³, 小坂 義種³, 中野　　 赳⁴

Kazumoto MURATA¹, Hidetaka WAGAYAMA¹, Atsuya SHIMIZU¹, Kenji TAKEUCHI², Mikio KUNIYOSHI¹, Yukihiko TAMEDA³, Yoshitane KOSAKA³, Takeshi NAKANO⁴

¹南勢町立病院内科, ²南勢町立病院外科, ³三重大学検査医学, ⁴三重大学第1内科

¹Department of Internal Medicine , Nansei Municipal Hospital, ²Department of Surgery, Nansei Municipal Hospital, ³Department of Laboratory, Mie University School of Medicine, ⁴The First Department of Internal Medicine, Mie University School of Medicine

キーワード : Choledochoascariasis, Inner tube Sign

We experienced one case of choledochoascariasis with acute pancreatitis, which we subjected to an ultrasonographic study. A 76-old woman suddenly began to suffer from colicky epigastralgia and right upper quadrant pain coupled with cold sweat. An ultrasonographic (US) study conducted upon admission showed echogenic stripes, partially containing a central, longitudinal anechoic tube (inner tube sign) with activity in the gallbladder (GB), therefore it was easy to diagnose as ascariasis. On the second day after admission, we lost ascaria in the GB. On the third day we found an inner tube sign in a dilated common bile duct (CBD). This later we showed a linear shadow in the CBD by ERCP. By following up the choledochoascariasis with US, we found that the patient had colicky pain when ascaria invaded the papillary muscle, in CBD completely or GB the colicky pain disappeared and the colicky pain appeared again when it fell into CBD. We can therefore conclude that choledochoascariasis should be considered as one of differential diagnosis of epigastralgia or right upper quadrant pain.