全内臓逆位症における腹腔鏡下胆嚢摘出術の経験

Laparoscopic Cholecystectomy in the Patient with Situs Inversus Totalis

　完全内臓逆位症を伴った胆嚢結石症に対して腹腔鏡下胆嚢摘出術を施行した．症例は68歳，男性．小腸アニサキス症の疑いにて当院で精査および加療中に左季肋部痛が出現し，胆嚢結石症の診断で手術目的に外科に転科となった．胸部単純写真で右胸心を，腹部超音波検査および腹部CTでは実質臓器の完全逆位を認めた．手術は腹腔鏡下胆嚢摘出術とし，臍上部に12mm，心窩部に10mm，左季肋部乳頭線上，前腋窩線上に5mmのカニューラをそれぞれ挿入し手術を進めた．手術はおおむね問題なく遂行できた．術後経過は良好で，第4病日目に退院した．完全内臓逆位症を伴った胆嚢結石症に対する腹腔鏡下胆嚢摘出術は安全に行うことが可能な術式であると言える．

We report a patient with situs inversus totalis who underwent laparoscopic cholecystectomy. A 68-year-old man who had been admitted to our hospital with an initial diagnosis of anisakiasis, presented with left side ab-dominal pain. A chest x-ray film revealed dextrocardia. Abdominal ultrasonography and computed tomography confirmed the diagnosis of cholecystolithiasis, as well as situs inversus with the liver and gallbladder on the left side and the spleen on the right. Cholecystectomy was performed laparoscopically in a reverse fashion.