胆囊皮膚瘻を伴う重症胆囊炎に対し，保存的治療後に待機的腹腔鏡下胆囊摘出術で治療しえた1例

Interval laparoscopic cholecystectomy for cholecystocutaneous fistula : A case report

◆要旨：症例は64歳，女性，右側腹部痛を主訴に来院した．検査の結果，胆囊炎，胆囊周囲膿瘍と腹壁に連続する膿瘍を認めた．経皮的ドレナージと抗菌薬投与を行い，炎症は速やかに改善した．炎症が消退したのち，待機的に腹腔鏡下胆囊摘出術を行い治療しえた．胆囊皮膚瘻は，診断技術や治療法の進歩した現代においては稀な病態である．多くの症例で可及的に開腹手術による外科的治療を行っているが，待機的に腹腔鏡下手術で治療を完遂した文献は，本邦では自験例を除けば報告はない．適切なドレナージと抗菌薬投与によって，胆囊皮膚瘻を伴う重症胆囊炎に対しても腹腔鏡下手術を行うことで安全かつ低侵襲に治療が可能になると考えられた．

　We herein report a successful case of interval laparoscopic cholecystectomy for cholecystitis with a cholecystocutaneous fistula （CCF）. A 64-year-old woman complaining of severe right upper quadrant pain visited our hospital. A series of examinations revealed that she had cholecystitis, a pericholecystic abscess and a connection to the abdominal wall. After percutaneous drainage of the abdominal wall abscess, interval laparoscopic cholecystectomy was performed without complications. CCF is a rare complication of gallbladder diseases in recent years and laparotomy treatments are required in most patient. Review of the literature revealed that this is the first patient with CCF who had undergone interval laparoscopic cholecystectomy without any complications in Japan. Interval laparoscopic surgery after percutaneous drainage and adequate antimicrobial treatment appears a safe and minimally invasive technique for managing severe cholecystitis with CCF.