腹腔鏡下手術を施行しえた胆囊胃瘻の1例

A case of cholecystogastric fistula treated by laparoscopic surgery

◆要旨：患者は48歳，男性．5年前に胆囊結石症，慢性胆囊炎と診断されていた．倦怠感，肝機能異常の精査のために当院を受診した．精査の結果，胆囊胃瘻が形成されており，それによる慢性的な胆囊炎，胆管炎が原因と診断した．病態把握後，腹腔鏡下手術が可能と判断し，腹腔鏡下胆囊摘出，瘻孔切除術を行った．胆囊消化管瘻のなかでも胆囊胃瘻の頻度は少なく，術前に診断がつかない場合もある．また，胆囊消化管瘻に対する腹腔鏡下手術は，高度炎症のため困難な場合が多いと想像される．今回筆者らは，術前に詳細に病態を把握することで術式をプランニングし，安全に腹腔鏡下手術を行うことができた胆囊胃瘻の1例を経験したので，文献的考察を加えて報告する．

A 48-year-old man who was diagnosed with cholecystolithiasis and chronic cholecystitis 5 years previously presented to our hospital with fatigue and abnormal hepatic function. On examination, we noted a cholecystogastric fistula that we believed may have been caused due to chronic cholecystitis and cholangitis After understanding the underlying pathological conditions, laparoscopic surgery was considered to be possible ; therefore, laparoscopic cholecystectomy and fistulectomy were performed. Among the cases of cholecystointestinal fistula, the incidence of cholecystogastric fistula is low, and its diagnosis is occasionally difficult. Moreover, laparoscopic surgery is believed to be difficult to perform for cholecystointestinal fistula due to the potential for serious inflammation. In the present report, we described a case of cholecystogastric fistula that was safely treated by laparoscopic surgery after the preoperative pathological conditions were carefully understood, and provided a literature-based discussion.