101歳の胆囊捻転症に対して腹腔鏡下胆囊摘出術を施行した1例

A case of laparoscopic cholecystectomy for gallbladder volvulus in a 101-year-old patient

◆要旨：胆囊捻転症は胆囊の血流障害をきたし，時間の経過とともに病態が急速に悪化し，迅速な対応が必要である．本邦では高齢化に伴い90歳以上の超高齢者が増加し，手術加療を行う場合は術後合併症のリスクが高い．今回われわれは，101歳の胆囊捻転症に対して腹腔鏡下胆囊摘出術を施行し，救命できた1例を経験した．症例は101歳の女性で，腹痛と嘔吐を主訴に当院へ受診した．胆囊捻転症と診断し，緊急で腹腔鏡下胆囊摘出術を施行した．術後は大きな合併症なく経過し，術後11日目に自宅退院した．急性胆囊炎の原因疾患の1つである胆囊捻転症の治療は，たとえ患者が超高齢者であっても腹腔鏡下胆囊摘出術がよい適応となり得るため術前画像診断が非常に重要である．

　Gallblader volvulus is a disorder of blood flow to cholecystic that rapidly worsens over time and requires prompt treatment. In Japan, the number of elderly patients over 90 years old is increasing due to the aging of the population, and the risk of postoperative complications is high when surgical treatment is performed. In this study, we experienced laparoscopic cholecystectomy for a 101-year-old patient with gallbladder volvulus. She came to our hospital with complaints of abdominal pain and vomiting. She was diagnosed as gallbladder volvulus and underwent emergency laparoscopic cholecystectomy. The postoperative course was uneventful and the patient was discharged home on the 11th postoperative day. Even in the very elderly, preoperative imaging is very important because gallbladder volvulus, one of the causes of acute cholecystitis, is a good indication for laparoscopic cholecystectomy.