A CASE OF AMPUTATION NEUROMA OF THE COMMON BILE DUCT

A case of amputation neuroma which occurred in the common bile duct after surgery for cholelithiasis is reported. The patient, a 53-year-old woman was admitted to our hospital with a chief complaint of abdominal pain. Seventeen years previously, she had undergone cholecystectomy, choledochotomy, T-tube drainage and papillotomy under the diagnosis of cholelithiasis. The endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography disclosed a stenosis of the common bile duct with a residual cystic duct and an elevated mass was found adjacent to the upper end of the stenotic area with a smooth margin. It was clarified by laparotomy and choledochotomy that the mass was covered with normal mucosa of the bile duct. The mass was excised including the residual cystic duct and the stenotic segment and then anastomosis of the common hepatic duct and jejunum was performed. The excised mass was slightly hard in elasticity and 12×7×8mm in size. Pathological findings showed the mass to be a submucosal tumor appearing as if many nerve fascicles were buried in densely proliferative connective tissue. Immunohistological findings revealed that S-100 protein, the neuron-secific protein, and neuron-specific enolase were both positive in the tumor, and amputation neuroma was diagnosed.