腹腔鏡下手術中の腹腔内落下胆嚢結石による腹壁膿瘍の1例

A Case of Abdominal Wall Abscess due to a Gallbladder Stone Dropped into the Abdominal Cavity during Laparoscopic Cholecystectomy

　内視鏡下手術中の落下胆嚢結石による腹壁膿瘍の1例を経験した．症例は59歳，女性で，1994年3月に胆嚢管に嵌頓していた結石を術中に腹腔に落下させてしまい，結局，回収できなかった．1995年12月に患者が右側上腹壁の腫瘤に気づいた．エコー，CTで遺残した結石が原因の膿瘍と判明し，局所麻酔下に2回切開排膿したが，結石は排出されず膿瘍は治癒しなかった．そこで，1997年1月に全身麻酔下に第11肋間に嵌入した結石を摘出した．その後は順調に回復した．落下胆嚢結石による膿瘍の治療に関しては，結石の除去を第一義的に考えるべきである．

We experienced an abdominal wall abscess due to a gallbladder stone dropped into the abdominal cavity during laparoscopic cholecystectomy. The patient was a 59-year-old female who was operated in March 1994. During the procedure, a stone within the cystic duct dropped into the abdominal cavity. We tried to retrieve this stone, but in vain. In December 1995, she noticed a mass at the right upper abdominal wall. Echogram and CT showed an abscess due to the stone that was left behind. Incision and drainage were performed twice under local anesthesia.