腹腔鏡下胆嚢摘出術が有用であった胆嚢捻転症の2例

Two Cases of Acute Torsion of the Gallbladder Treated by Laparoscopic Cholecystectomy

　症例1は81歳，女性，急性胆嚢炎でPTGBDを施行したが改善せず，PTGBD後8日目に腹腔鏡下胆嚢摘出術（以下，LC）を施行した．胆嚢は時計方向に180度捻転していたが遊走胆嚢は認めなかった．症例2は74歳，女性．急性胆嚢炎，胆嚢捻転症を疑い，PTGBDを施行したが改善せず，PTGBD後4日目にLCを施行した．胆嚢はGrossl型の遊走胆嚢であり時計方向に270度捻転していた．症例1のように，遊走胆嚢でなくても胆嚢捻転を発症することが示された．胆嚢捻転症では胆嚢体底部の炎症性変化は高度であるが，胆嚢頸部からCalot三角部では軽度であるという特徴があり，LCのよい適応である．

An 81-year-old woman. (Case 1), and a 74-year-old woman, (Case 2), were admitted to our hospital with a diagnosis of acute cholecystitis. In spite of drainage of the gallbladder, their general condition did not improve. Laparoscopic cholecystectomy (LC) was performed 8 and 4 days after the drainage procedure in cases 1 and 2, respectively. During the operation, the gallbladders were found to be twisted clockwise 180 and 270 degrees in the two patients. respectively. Gross type 1 “floating gallbladder” was observed in case 2 but not in Case 1.