肝臓からの索状物による絞扼性胆囊炎の1例

A case of strangulated cholecystitis caused by a band from the liver

◆要旨：症例は84歳，女性．腹部手術歴はなく，2日前から腹痛と嘔吐が出現し，増悪傾向となったため受診した．微熱があり，右季肋部から右下腹部にかけて筋性防御を伴う圧痛を認めた．血液検査では炎症反応が上昇しており，腹部造影CTでは胆囊底部，体部の腫大と頸部の著明な狭窄を認め，胆囊の造影効果は減弱し，腹水を伴っていた．以上から胆囊捻転による胆囊の壊死，穿孔を疑い，緊急で腹腔鏡下胆囊摘出術を行った．肝外側に暗緑色の腹水を認め，胆囊は色調不良であったが穿孔は認めなかった．GrossⅡ型の遊走胆囊の頸部が，肝臓からの索状物によって絞扼されており，この索状物を含めるようにして胆囊を摘出した．術後経過は良好で術後8日目に退院した．病理検査では，標本内に肝実質組織は認めなかった．絞扼性胆囊炎の報告は稀であり，文献的考察を加えて報告する．

　An 84-year-old woman with no history of abdominal surgery visited our hospital and presented with right lower abdominal pain and vomiting that appeared 2 days earlier. She had a slight fever and tenderness over the right hypochondrium and lower right abdomen with muscular defense. Blood tests showed elevated inflammatory reactions, and abdominal contrast-enhanced computed tomography showed swelling of the fundus and body of the gallbladder and marked neck narrowing, with a reduced contrast effect in the gallbladder and ascites. Based on these findings, we suspected necrosis and perforation of the gallbladder due to torsion and performed an emergency laparoscopic cholecystectomy. Dark green ascites was found on the lateral side of the liver, and the gallbladder was discolored, although no perforation was detected. The neck of the gross type II gallbladder was strangulated by a band from the liver, and the gallbladder was excised together with this band. The patient's postoperative course was favorable, and she was discharged on the 8th postoperative day. Upon pathological examination, no hepatic parenchymal tissue was found in the specimen. Reports on strangulated cholecystitis are rare, and we present this case along with a review of relevant literature.