腹腔鏡下胆嚢摘出術後のLuschka管胆汁瘻の1例

A case of bile leakage from an accessory duct of Luschka after laparoscopic cholecystectomy

　腹腔鏡下胆嚢摘出術後の合併症の一つに胆汁瘻が挙げられる．胆嚢床にあるLuschka管の損傷は，腹腔鏡下手術時には気づかずに術後胆汁瘻の原因となる．今回，腹腔鏡下胆嚢摘出術5日後に胆汁瘻を認め，胆道造影にてLuschka管の損傷を確認し保存的加療を施行した症例を報告する．症例は49歳，女性．右副腎腫瘍と胆石症の診断で腹腔鏡下右副腎および胆嚢摘出術を施行した．胆嚢は炎症の所見もなく容易に？離，摘出できた．術後5日目に腹痛が出現し，DIC-CTで造影剤の流出を認めた．ERCPでLuschka管損傷による胆汁瘻と診断し，ENBDを施行した．さらに，腹痛が続くため経皮的穿刺ドレナージを追加し治癒した．

Postoperative bile leakage has been reported to occur in 0.4% to 2.7% of cases undergoing laparoscopic cholecystectomy because of technical problems with a cystic duct closure, diathermic injuries to the biliary tree or failure to notice anomalous bile duct injuries. The ducts of Luschka, accessory bile ducts within the gall blad-der fossa, can be injured during cholecystectomy. We report a case of bile leakage from a small bile duct of Luschka and the treatment.