腹腔鏡下胆囊摘出術施行時に発生した心囊気腫の1例

Pneumopericardium during laparoscopic cholecystectomy : a case report

◆要旨：患者は75歳，女性．主訴は腹痛．2012年に食後の腹痛があり当院を受診した．腹部超音波検査で胆石症と診断され当科紹介となり，腹腔鏡下胆囊摘出術を施行した．術中に横隔膜に小孔を認めた．交通の状態などは不明であったが，胸腔側に交通がある可能性もあり，気腹圧を落とし手術を続行した．術中バイタルサインなど問題なく手術は終了した．術後1日目に胸部痛が出現し確認のためCT検査を行ったところ，心囊気腫を認めた．症状は自然軽快し経過観察可能と判断した．術後4日目に軽快退院した．術後再来時に確認でCT検査を施行したが心囊気腫は消失していた．腹腔鏡下胆囊摘出術施行時に発生した心囊気腫の報告はこれまでなく報告する．

We report a rare case of pneumopericardium with literature review. A 75-year-old woman with abdominal pain was diagnosed as having cholecystolithiasis at the Department of Gastroenterology of our hospital in 2012. Laparoscopic cholecystectomy was performed for cholelithiasis the following month. A small hole was observed in the diaphragm during the operation. Abdominal pressure was reduced, and the operation continued without any complication. The patient reported chest pain on the first day after the operation. Pneumopericardium was diagnosed by computed tomography（CT）. The symptoms resolved without any treatment. The patient was discharged on the fourth day after surgery. When CT scan was performed again, pneumopericardium had disappeared. There is no previous report of pneumopericardium occurring during laparoscopic cholecystectomy. The case is reported with literature review.