術前診断し腹腔鏡下に治療しえた胆囊十二指腸瘻の1例

Laparoscopic treatment of cholecystoduodenal fistula diagnosed preoperatively

◆要旨：患者は76歳の男性．当院に白内障手術目的の入院中に発熱を認めた．血液検査で肝・胆道系酵素値が上昇し，腹部CT検査で胆道気腫と総胆管結石を認めた．また十二指腸と胆囊頸部に連続性を認めたため胆囊十二指腸瘻の存在が疑われた．上部消化管内視鏡および造影検査で十二指腸に約5mm大の瘻孔を認め胆囊十二指腸瘻と診断した．総胆管結石症に対して内視鏡的逆行性胆管膵管造影（以下，ERCP）で除去後，胆囊十二指腸瘻に対して腹腔鏡下に瘻孔切除と胆囊摘出術を施行した．胆囊十二指腸瘻は，術前診断ができて瘻孔周囲の炎症が軽度であれば，低侵襲手術としての腹腔鏡下手術が有用であると思われた．

　We report a 76-year-old man who developed a fever during hospitalization for cataract surgery at our hospital. A blood test revealed elevated liver and biliary enzyme values, and an abdominal CT examination showed pneumobilia and common bile duct stones. The presence of a cholecystoduodenal fistula was suspected based on the continuity of the duodenum and gallbladder neck, and an upper gastrointestinal endoscopy revealed a fistula of approximately 5mm in the duodenum. Consequently, the patient was diagnosed as having a cholecystoduodenal fistula. After ERCP for choledocholithiasis, we performed a laparoscopic fistectomy and cholecystectomy. Laparoscopic surgery may be useful as a minimally invasive procedure if a cholecystoduodenal fistula can be diagnosed preoperatively and the inflammation surrounding the fistula is mild.