Hem-o-lokクリップがCTにて明瞭に描出された腹腔鏡下胆囊摘出術の1例

A case of clear visualization of Hem-o-lok clips on CT imaging after laparoscopic cholecystectomy

◆要旨：症例は40歳，女性．3日前から熱発，上腹部痛，嘔吐を認めた．精査の結果，急性胆囊炎と診断され同日緊急で腹腔鏡下胆囊摘出術を施行した．術後3日目に嘔吐と右上腹部痛を認めたため単純CT検査を実施したところ，肝床部にhigh density areaが描出された．画像解析の結果，手術に使用したHem-o-lokクリップXLに一致することがわかった．サイズごとにHem-o-lokクリップ自体をX線とCTで撮影し描出されるか検証した．X線検査ではHem-o-lokクリップはサイズにかかわらず描出されないが，CT検査ではサイズが大きくなるにつれ明瞭に描出されることが判明した．スライス幅の条件を変えて検証も行い，薄いスライス幅での条件のほうがより明瞭に描出された．

　A 40-year-old woman with a 3-day history of epigastric pain and vomiting presented to the emergency department of our hospital because of a worsening fever. After close examination, she was diagnosed with acute cholecystitis and was referred to the Department of Surgery, where an emergency laparoscopic cholecystectomy was performed. On the 3rd postoperative day, she experienced vomiting and right upper quadrant pain. A plane computed tomography（CT）scan revealed a high-density area resembling a foreign structure around the liver bed. Image analysis revealed that this area corresponded to the size XL Hem-o-lok clip used during surgery. We examined the appearance of Hem-o-lok clips of each size using radiographs and CT to verify their visibility. We found that the Hem-o-lok clips were not depicted on radiographs regardless of the size but were depicted on CT scan with increasing clarity as the size increased. Furthermore, we demonstrated that clip visualization was clear on thinner slices on CT scan.