生後6か月で腹腔鏡下胆囊摘出術を施行した乳児胆石性胆囊炎の1例

Laparoscopic cholecystectomy for calculous cholecystitis in a 6-month-old infant : A case report

◆要旨：症例は6か月の男児．活気低下，不機嫌，嘔吐を主訴に，前医を受診した．血液検査で肝胆道系酵素の上昇があり，腹部超音波検査で胆囊結石を複数認め，胆石性胆囊炎と診断された．保存的加療で軽快を認め退院したが，その後1か月で2回再燃した．有症状の胆石症のため，手術目的に当院へ紹介入院となった．遺伝性球状赤血球症などの溶血性疾患，先天性胆道拡張症は否定的であった．腹腔鏡下胆囊摘出術を施行したが，術翌日の血液検査で胆道系酵素の上昇を認め，CTで総胆管内に結石を認めた．胆囊結石の総胆管への落石と考えられたが，保存的加療により術後4日目には自然排石され，術後9日目で退院となった．

　A 6-month-old boy was admitted to our hospital because of cholecystitis. Abdominal ultrasound showed several gallbladder stones. Although he was discharged after conservative treatment, there was a recurrence of cholecystitis twice in the following month. He had no recognized predisposing factors such as hemolytic diseases or choledochal cyst. Laparoscopic cholecystectomy was performed at six-months of age. Blood tests on the day following the operation showed an increase in direct bilirubin. Abdominal computed tomography revealed a stone in the common bile duct. It was thought that a gallbladder stone had fallen into the common bile duct. The stone was spontaneously expelled on the 4th day after the operation with only conservative treatment. He was discharged on the 9th postoperative day.