抗凝固療法中の胆囊出血に対して腹腔鏡下胆囊摘出術を施行した1例

Laparoscopic cholecystectomy for gallbladder bleeding during anticoagulant therapy

◆要旨：胆囊出血は稀な病態であるが，近年では抗凝固療法中の発症例が散見される．今回，筆者らは待期的に腹腔鏡下胆囊摘出術を施行した，抗凝固療法中の胆囊出血症例を経験したので報告する．患者は65歳，男性．心筋梗塞の既往があり，抗凝固薬を内服中であった．右季肋部痛を主訴に受診し，血液検査で肝胆道系酵素の上昇を認め，CT，MRCPにて胆囊出血と診断された．保存的治療で症状は改善し，約1か月後に腹腔鏡下胆囊摘出術を施行した．胆囊および周囲組織に明らかな炎症所見は認められず，安全に手術施行可能であった．術後経過は良好で，術後4日目に退院した．

　Although gallbladder bleeding is a rare condition, recently, it has occasionally been reported, occurring during anticoagulant therapy. We report a patient with such condition who underwent laparoscopic cholecystectomy. A 65-year-old man with right upper abdominal pain was admitted to our hospital. Blood tests revealed liver dysfunction and abdominal CT scan and MRCP led to the diagnosis of gallbladder bleeding. Abdominal symptom improved by conservative therapy and laparoscopic cholecystectomy was performed one month after the onset of illness. There was no inflammation around the gallbladder and the surgery was performed safely. Postoperative course was uneventful and the patient was discharged on the fourth day.