総胆管結石による胆道後腹膜瘻

Spontaneous biloma presenting as rapidly expanded retroperitoneal fluid collection : A case report

　73歳女性．既往歴なし．5日前よりの右腰背部痛を主訴に当科受診．単純CTにて右腎周囲の液体貯留，総胆管結石を指摘され入院，炎症反応高値であり安静，抗菌薬加療が開始された．入院後の造影CTでは右後腹膜腔の液体貯留の拡大を認めた．排泄層では尿路は保たれていた．第6病日に超音波ガイド下に穿刺を行い，排液中の胆汁成分を確認，胆道後腹膜瘻の診断に至った．今回は総胆管結石に起因した胆道内圧の上昇，それに伴う胆汁性囊胞の穿破が原因と考えられた．

Abstract

A 73-year-old female was admitted to our institution with right lower back pain. She had right CVA tenderness. CT demonstrated perirenal fluid collection and choledocholithiasis. Laboratory examination indicated inflammation of high degree. There were no findings related with acute bleeding. We started anti-biotic therapy, but her symptom was not improved. Follow-up CT and MRI showed that retroperitoneal fluid collection was expanded from dorsal of inferior vena cava to the anterior right psoas, with no sign of urinary tract injury. We performed echo-guided retroperitoneal puncture at sixth hospital day. The brownish yellow fluid was drained, and laboratory examination showed the elevation of bilirubin level in the drainage fluid. We diagnosed the spontaneous bile duct fistula that was connected with retroperitoneal space. We speculated the cause of this case was the increase of bile duct internal pressure because of choledocholithiasis (Rinsho Hinyokika 72 : 569-572, 2018).