癒着性イレウスに対する開腹手術後，腹腔鏡下手術が可能であった総胆管結石合併胆囊十二指腸瘻の1例

Laparoscopic surgery of cholecystoduodenal fistula with choledocholithiasis, after laparotomy for adhesional ileus : a case report

症例は84歳の女性で，イレウスの診断で紹介され入院となった．腹部CT検査で総胆管結石と肝内胆管に気腫を認めた．総胆管結石を合併した胆道消化管瘻を疑った．近医でイレウス管挿入後19日が経過していたため，イレウスに対し入院当日，開腹手術を施行した．手術所見は癒着性イレウスであった．全身状態の改善を待ち，精査を行い，総胆管結石合併胆囊十二指腸瘻と診断した．イレウス手術後40日目に低侵襲を考え，腹腔鏡下手術を施行した．手術は瘻孔切除術，胆囊摘出術，総胆管切開術，Tチューブドレナージ術を施行したが，開腹手術による癒着はほとんど認められなかった．総胆管結石合併胆囊十二指腸瘻に対する腹腔鏡下手術は有用と考えられた．

　A 84-year-old woman was referred to our hospital with a diagnosis of ileus and entered our hospital. An abdominal CT revealed choledocholithiasis and pneumobilia. Cholecystoduodenal fistula with choledocholithiasis was suspected. Because 19 days passed without improvement after insertion of an ileus tube in a local hospital, we performed laparotomy for the ileus on admission to our hospital. The operative findings revealed adhesional ileus. After her general condition improved, we performed close inspection, which revealed cholecystoduodenal fistula and choledocholithiasis. Forty days after the operation for the ileus, we performed fistulectomy, cholecystectomy, choledochotomy and T-tube drainage by laparoscopic surgery. We did not recognize any adhesion due to the laparotomy. Laparoscopic surgery of cholecystoduodenal fistula with choledocholithiasis may be considered as a useful surgical method.