CTにて術前診断しえた特発性胆囊穿孔に対して腹腔鏡下胆囊摘出術を施行した1例

A case of idiopathic perforation of gallbladder preoperatively diagnosed by contrast enhanced CT

◆要旨：患者は45歳，女性．SLE，ループス腎炎の既往があり，ステロイドの内服加療中であった．発熱，右背部痛を主訴に来院した．急性腎盂腎炎の診断で緊急入院となり，抗菌薬治療を開始した．入院8日目に突然の腹痛の訴えがあり，造影CTにて胆囊の虚脱所見，胆囊周囲液体貯留の出現に加え，胆囊壁の一部に欠損が認められ，胆囊穿孔を疑った．腹腔試験穿刺では胆汁様腹水の貯留が確認された．特発性胆囊穿孔の診断で緊急腹腔鏡下胆囊摘出術を施行した．胆囊体部腹側に約5mmの穿孔部を1か所認め，病理では全層に炎症細胞の浸潤を認めるのみであった．本邦において術前に特発性胆囊穿孔を正確に診断し，腹腔鏡下に切除しえたとする報告は非常に稀である．

We herein report a rare case of idiopathic perforation of gallbladder preoperatively diagnosed by CT scan. A 45-year-old woman with a history of SLE and lupus nephritis was referred to our hospital for high fever and right-sided back pain. She was diagnosed with acute pyelonephritis and an antibiotic therapy was introduced immediately. On the 8th day of admission, she suffered an acute abdomen. Contrast enhanced CT scan demonstrated massive ascites without free air and a defect within the gallbladder wall ; a diagnosis of gallbladder perforation was suspected. Abdominal paracentesis confirmed retention of bile. We performed an emergent laparoscopic cholecystectomy under a diagnosis of perforation of the gallbladder. The gallbladder was perforated at its body and the examination of the specimen revealed non-specific inflammation, confirming the final diagnosis of idiopathic perforation of the gallbladder.