腹腔鏡下胆囊摘出術後に肝被膜下血腫をきたした1例

A case of subcapsular hematoma of the liver following laparoscopic cholecystectomy

◆要旨：患者は78歳，男性．6年前総胆管結石に対し内視鏡的に切石術を施行された．胆石も認めていたが手術は施行されなかった．今回，血便を認め大腸内視鏡検査で直腸癌と診断され，外科紹介となった．術前のCTで総胆管結石と胆石を認めた．総胆管結石に対し内視鏡的に切石術を施行し，1週間後，直腸癌と胆石症に対し腹腔鏡下直腸前方切除術，胆囊摘出術を施行した．術後2日目に貧血の進行を認め，エコーとCTで，肝右葉に径11cmの被膜下血腫を認めた．腹腔内への明らかな出血は認めず，輸血などにて保存的に治療を行った．その後貧血の進行や血腫の増大も認めず，術後18日目に退院となった．今回，胆囊摘出術後の合併症としては稀な肝被膜下血腫の1例を経験したので報告する．

A 78-year-old man diagnosed with choledocholithiasis had undergone endoscopic lithotomy 6 years ago but did not undergo cholecystectomy for cholelithiasis. He was referred for an examination of hematochezia and was found to have rectal cancer. Preoperative CT findings revealed choledocholithiasis and cholelithiasis. Laparoscopic anterior resection and cholecystectomy were performed one week after endoscopic lithotomy for choledocholithiasis. Two days after operation, progressive anemia was noted and abdominal CT and US showed a subcapsular hematoma of the liver. The patient improved with conservative therapy and was discharged. To prevent such complications following laparoscopic surgery, it is important that forceps are carefully handled during closure of the liver. We herein report a case of subcapsular hematoma of the liver following laparoscopic cholecystectomy with review of the literature.