迷入クリップを核とした遺残胆囊結石症に再度腹腔鏡下手術を施行した1例

A case of gallstones caused by migration of the cystic duct metal clip in the cystic duct remnant

◆要旨：患者は57歳，男性で，8年前に胆石症に対して腹腔鏡下胆囊摘出術（以下，LC）を受けた．今回，肝胆道系酵素の異常を指摘され精査を行ったところ，CT，ERCにて遺残胆囊内に結石を認めた．遺残胆囊結石症と診断し，再度腹腔鏡下に手術を行った．切除標本にて切除された胆囊内に壁より完全に遊離した結石を1個認め，LC時に使用した金属クリップを核としていた．金属クリップの総胆管内への迷入は報告されているが，遺残胆囊内への報告はなかった．

　We experienced a case of cholelithiasis in the cystic duct remnant, caused by the metal clip which had been engaged at laparoscopic cholecystectomy（LC）eight years before. The patient had underwent LC for cholelithiasis in July, 1998. He entered to our hospital because of increasing concentrations of serum transaminases and alkaline phosphatase, and then endoscopic retrograde cholangiography reveled a stone shadow in the cystic duct remnant. He underwent LC. The stone was macroscopically classified to be a pigmented stone with a nidus comprised of the metal clip that had been used in the prior LC. We report this case because cholelithiasis in cystic duct remnant caused by metal clips was very rare.