1歳の胆囊捻転症に対し術中ICG蛍光観察を用いた単孔式腹腔鏡下胆囊摘出術を施行した1例

Single-incision laparoscopic cholecystectomy with intraoperative ICG fluorescence observation for gallbladder torsion in a one-year-old boy

◆要旨：症例は1歳，男児．突然の嘔吐，機嫌不良にて前医に緊急入院となった．翌日より発熱も認め，第2病日目に腹部超音波で胆囊捻転症を疑われ，当院へ紹介搬送となった．腹部超音波，造影CT検査の結果から胆囊捻転症を疑い緊急手術を施行した．術中所見で胆囊は頸部で360度反時計回りに捻転していた．捻転を解除し，単孔式腹腔鏡下胆囊摘出術を施行した．術中にICG蛍光観察法による胆道造影を行い，総胆管を同定し，胆管損傷がないことを確認した．術後経過は良好であり，術後3日目に退院した．1歳の胆囊捻転症に対し，術中ICG蛍光観察を施行して総胆管の走行を確認し，安全に単孔式腹腔鏡下胆囊摘出術を施行したので報告する．

　A one-year-old boy was urgently admitted to a previous hospital due to sudden-onset vomiting and lethargy. On the day following admission, an abdominal ultrasound suggested gallbladder torsion, prompting referral to our hospital. Based on findings from abdominal ultrasound and contrast-enhanced computed tomography（CT），gallbladder torsion was suspected, necessitating emergency surgical intervention. Intraoperatively, the gallbladder was found to be rotated 360°counterclockwise at the neck. Following detorsion, a single-incision laparoscopic cholecystectomy was performed. The common bile duct was intact, confirmed visually using indocyanine green（ICG） fluorescence imaging. The postoperative course was uneventful, and the patient was discharged on the third postoperative day. This case highlights the feasibility of single-incision laparoscopic cholecystectomy with intraoperative ICG fluorescence imaging in the management of gallbladder torsion in an infant.