腹腔鏡補助下にイレウス解除術を行った胆石イレウスの2例

Laparoscopic enterolithotomy for gallstone ileus : two case reports

◆要旨：症例1は90歳，男性．胆石性胆囊炎にて入院し保存的加療中に結石が十二指腸へ落石し，その後イレウス症状が出現した．胆石イレウスの診断にて緊急手術を行い，腹腔鏡補助下に結石が嵌頓した回腸の部分切除を行った．症例2は71歳，男性．脱水，嘔吐にて救急搬送され，敗血症，急性腎不全の診断で入院となった．腹部CTにて胆石イレウスと診断し，腹腔鏡補助下に小腸切開切石術を行った．胆石イレウスに対する治療法として，胆道系手術を同時に行うか否かは議論が分かれるが，高リスク患者に対しては腹腔鏡補助下にイレウス解除のみを行う本術式が安全で有用であると考えられる．

　Case 1 : A 90-year-old man was admitted for cholecystitis. While he was been treated conservatively, symptoms of intestinal obstruction occurred due to gallstone migration to the duodenum. A diagnosis of gallstone ileus was made and laparoscopic-assisted bowel resection was performed. Case 2 : A 71-year-old man was referred to our hospital because of dehydration and vomiting. A diagnosis of sepsis and acute renal dysfunction was made. An abdominal CT scan showed gallstone ileus, and the patient underwent a laparoscopic-assisted enterotomy and stone extraction. Whether or not closure of biliary fistula should be performed simultaneously in surgical treatment for gallstone ileus is still controversial. Our experiences suggest that a laparoscopic-assisted surgery for gallstone ileus without biliary fistula closure is safe and useful in high risk patients.