腹腔鏡下胆嚢摘出術後の仮性肝動脈瘤が胆道穿破を来した1例

Hepatic Artery Pseudoaneurysm and Hemobilia after Laparoscopic Cholecystectomy

　72歳の女性で，腹腔鏡下胆嚢摘出術後6日目に発熱，黄疸にて発症し，大量消化管出血を来した術後仮性肝動脈瘤の胆道穿破の1例を経験した．緊急経動脈カテーテル塞栓術により止血，救命することができた．若干の文献的考察を加えて報告する．腹腔鏡下胆嚢摘出術の際に，慢性萎縮性胆嚢炎をはじめとする高度炎症例では，特にCalot三角部の剥離操作を解剖学的構造を明らかにしながら，十分慎重に行うべきであることを痛感した．また，腹腔鏡下胆嚢摘出術後に黄疸や肝機能異常を認めた場合には，本症も念頭に置き，慎重に検査，治療を進める必要があると考えられた．

A case of hepatic artery pseudoaneurysm and hemobilia following laparoscopic cholecystectomy is reported. A 72-year-old woman was consulted 6 days after laparoscopic cholecystectomy with high fever and jaundice. Soon after, she had massive melena, and celiac arteriogram revealed an aneurysm located at the truncal portion of the right hepatic artery, which was successfully embolized. Recently, the laparoscopic procedure has been applied for severe cholecystitis. This report emphasizes the importance of careful management of biliary structures to avoid biliary and vascular injuries that can result from using this surgical procedure.