腹腔鏡下胆囊摘出術を施行した胆囊捻転症の1例

Laparoscopic cholecystectomy for torsion of the gallbladder

◆要旨：患者は右季肋部痛を主訴とした29歳のやせ型の男性．血液検査所見では白血球数，CRPの軽度上昇を認めたが胆道系酵素の上昇はなかった．画像上は遊走胆囊で胆囊腫大は認めたが壁肥厚や結石はなかった．右季肋部痛が激しく急性胆囊炎を疑い，診断的治療の目的で腹腔鏡下手術を施行した．術中所見ではGross II型の遊走胆囊であり，胆囊が頸部で時計方向に360度捻転した胆囊捻転症であった．捻転を解除し胆囊を摘出した．術後経過は良好であった．病理組織検査では胆囊壁に著明な急性虚血性壊死を認めた．

　Torsion of the gallbladder is rare and prompt surgery is necessary for uneventful postoperative course. A 29-year-old male admitted at our hospital with acute right upper quadrant pain. He was thin and had no particular medical history. Laboratory investigation showed slight elevation of white cell count and CRP. Other blood chemistry parameters were unremarkable. Preoperative CT scan demonstrated a massively distended floating gallbladder outside its fossa and inferior to the liver. Because of severe right upper quadrant pain, an emergency laparoscopy was done with a diagnosis of acute cholecystitis.

　The gallbladder was twisted 360°in a clockwise fashion. Laparoscopic derotation and cholecystectomy was performed uneventfully. The histopathology report of the specimen showed gangrenous necrotizing cholecystitis.