高齢者気腫性胆囊炎に対して一期的腹腔鏡下胆囊摘出術を施行した1例

Emphysematous cholecystitis treated by laparoscopic cholecystectomy for geriatric patient

◆要旨：患者は91歳，男性．前日夜より右季肋部痛が出現し当院を受診した．精査にて胆囊炎を疑い入院となった．炎症反応は軽度であったため保存的治療を開始したが，その後も発熱や炎症反応の悪化が認められた．入院後24時間経過時の腹部CT検査では胆囊腫大など胆囊炎所見の増悪に加え，胆囊内や壁内にもガス像の出現を認め，気腫性胆囊炎の診断にて腹腔鏡下胆囊摘出術を施行した．気腫性胆囊炎は急速に重篤な経過をたどるため，急性期手術を含めた外科的処置が必要になることが多い．今回，筆者らは気腫性胆囊炎に対して一期的に腹腔鏡下胆囊摘出術を施行した症例を経験したので文献的考察を含めて報告する．

　We report a 91-year-old man who presented to the hospital because of right hypochondrial pain from the previous night. He was diagnosed as acute cholecystitis and was admitted to the hospital. Although he was treated by conservative therapy because of mildly-inflamed acute cholecystitis, he continued to have a fever and his inflammatory response became worse. Approximately 24 hours after his admission, a follow-up abdominal CT scan revealed worsened acute cholecystitis with enlargement and gas shadow in the wall and lumen of the gallbladder. We performed emergency laparoscopic cholecystectomy since the diagnosis confirmed emphysematous cholecystitis. Because emphysematous cholecystitis is a serious disease with an aggressive course, urgent surgical procedure including acute-phase surgery is required. We report our case in detail with a literature review.