膽囊切除術適當嗎: 拉K引起的總膽管擴張合併膽汁鬱積
張美玉1、阮雍順1,2,3、沈榮宗1、耿俊閎1,2、王巽玄1,2
1高雄市立小港醫院 泌尿科；2高雄醫學大學附設醫院 泌尿科; 3高雄醫學大學 泌尿科
Cholecystectomy is necessary or not about that ketamine absue induces cholestasis with common bile duct dilatation?
Mei-Yu Jang1 , Yung-Shun Juan1,2,3, Jung-Tsung Shen1,Jiun-Hung Geng1,2, Hsun-Shuan Wang1,2
Department of Urology1, Kaohsiung Municipal Hsia-Kang Hospital, Kaohsiung, Taiwan; Department of Urology2, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology3, Kaohsiung Medical University, Kaohsiung, Taiwan
A 23-year-old woman was admitted due to upper and lower abdominal pain for a period of time. She had ketamine abuse since 6 years ago. She snorted ketamine powder about 3 gm/day. Lower urinary tract symptoms including frequency, voiding pain and suprapubic pain always bother her.
She stopped using ketamine for about 1 year due to pregnancy. Lower urinary tract symptoms got resolution. Unfortunately, she snorted ketamine again because of poor couple relationships. About 5 gm/day of ketamine powder snorting. One month later, she suffered from epigastralgia , abdominal pain, suprapubic pain and gross hematuria. She presented to Emergency room for help. The evaluation of her abdominal pain include an abdominal ultrasound that showed a dilated common bile duct (CBD) and gallbladder , CT scan of the abdomen that revealed dilatation of the common bile duct and wall thickening of urinary bladder, and an esophagoduodenoscopy that showed gastritis.
2 months later, she was seen in ER again due to severe abdominal pain. CT scan of the abdomen was performed again and showed common bile duct dilatation and suspect cholangitis. Laparoscopic cholecystectomy was done. Pathologic finding was abortive mucosal epithelium with inflammatory and edematous stroma and diffuse inflammatory infiltrates and Rokitansky-Aschoff sinues.
She still had ketamine abuse after operation. Severe abdominal pain and suprapubic pain troubled her. She asked urologist for further evaluation and treatment. The patient stopped ketamine abuse by combining pain control , infection control and psychotherapy. Dramatically symptoms and signs about abdominal pain got complete resolution one month later.
We report the case of ketamine abuse with cholestasis and common bile duct dilatation in the absence of an obstructive lesion. Cessation of ketamine abuse is the first line treatment and to avoid unnecessary operation.