胆囊捻転症と術前診断し早期退院が実現できた超高齢者（97歳）の1例

A case of gallbladder torsion in an elderly patient in which early discharge was possible due to a preoperative diagnosis and laparoscopic surgery

◆要旨：患者は97歳，女性．上腹部痛を自覚し当院救急外来を受診した．腹部造影CT検査で胆囊の著明な腫大と壁の肥厚を認めたが，胆囊壁は造影効果に乏しかった．胆囊管は総肝管との分岐後急な狭小化をきたしており，胆囊管もしくは胆囊頸部の捻転による胆囊捻転症と診断し，緊急腹腔鏡下胆囊摘出術を行った．胆囊頸部は180度時計周りに捻転し，胆囊壁は暗赤色に変色していた．術後経過は良好で第6病日に軽快退院となった．発症早期に診断し手術を施行できたことが，術後早期退院を実現できた要因である．超高齢者の胆囊捻転症は稀であるが，早期診断・治療の重要性を示す1例を経験したためこれを報告する．

A 97-year-old female consulted the Emergency Outpatient Unit of our hospital with upper abdominal pain. Contrast-enhanced abdominal computed tomography（CT） suggested torsion of the gallbladder involving the gallbladder cervix. Emergency laparoscopic cholecystectomy was performed. The gallbladder cervix was twisted in a clockwise direction at 180 degrees, and the peripheral gallbladder wall was dark-red, reflecting blood flow disturbance. The postoperative course was favorable. On the 6th postoperative day, the patient was discharged. Pathologically, necrosis of the gallbladder mucosa was noted, but there were no malignant findings. Early diagnosis and surgery may have contributed to an early discharge after surgery. Torsion of the gallbladder in elderly persons is rare. The present case suggests the importance of early diagnosis/treatment.