[Nasobiliary drainage for spontaneous bile peritonitis due to cholangiocarcinoma].

We report a case of cholangiocarcinoma presented with bile peritonitis, in which endoscopic nasobiliary drainage (ENBD) as well as pleural and abdominal drainages improved the general condition leading to a radical operation. The case was a 79-year-old woman with the chief complaints of fever and right hypochondralgia due to pleural effusion and infected ascites contaminated with bile including E. coli. However gall-stones were not recognized in any biliary trees. US-guided drainage was performed into the pleural and abdominal cavities because of poor condition. After continuous drainages, peritonitis was improved, but hematoemesis and tarry stool appeared. Emergent endoscopy revealed a multiple gastric ulcer, and the bleeding was stopped by an injection of ethanol. ERCP findings revealed a cholangiocarcinoma in superior and middle portion of the bile duct obstructed nearly completely. After improvement in general condition by ENBD, cholecystectomy, resection of extrahepatic bile duct and subtotal gastrectomy were performed followed the reconstruction with Roux-en-Y method. Postoperative course was uneventful and the patient was discharged at the postoperative 35th day. Thus, the appropriate and opportune multiple biliary drainages can save a patient with cholangiocarcinoma in poor condition and lead to tolerate the operation even if he or she is suffering from severe bile peritonitis.

[Clinical effect of combined chemotherapy with UFT, MMC and OK-432 in recurring or advanced cancer of the digestive organs].

The usefulness of UFTMO therapy (combined chemotherapy with UFT, MMC and OK-432) performed in 40 cases of recurring or advanced cancer of the digestive organs was investigated. According the response criteria by Koyama et al., of 40 eligible cases, the treatment was judged effective in 13, 2 CR and 11 PR cases with a response rate of 32.5%, while of the 35 complete cases, 2 CR and 9 PR cases made for 11 effective cases and a response rate of 31.4%. Side effects were observed in 58.3% of the 36 evaluated cases; of the subjective and objective side effects, however, none were serious enough to require cessation of administration, while stopping administration in the cases of abnormal laboratory findings resulted in rapid recovery. UFTMO therapy, therefore, is considered to be one of the beneficial treatments for recurring or advanced cancer of the digestive organs.