急性化膿性胆管炎を併発した原発性肝内結石症の1例

Intrahepatic Gallstones, Report of a Case

要旨　腹部USにて肝内のSOLを指摘され当科に精査のため入院．ERC所見から原発性肝内結石症と診断されたが，患者と家族が手術の延期を希望し一時退院．その後急性化膿性胆管炎を併発して死亡した1例をその剖検所見を含めて報告した．また過去8年間に当科と関連施設で経験した肝内結石症11例につき臨床的考察を加え，本症の画像診断における問題点を指摘した．

　During the past eight years, we encountered 11 cases of intrahepatic gallstones which were confirmed by operation or autopsy. Based on analysis of 11 cases our experiences were documented. Some considerations concerning diagnostic imaging of this disorder were described. A representative case was illustrated.

　A 60 year-old man who was a heavy drinker visited to a local medical doctor with complaints of abdominal pain and fever. Space-occupying lesion was suspected by abdominal ultrasonography. He was referred to our hospital because of complete check up of it. Multiple intrahepatic gallstones were demonstrated by ERC, CT and US. He and his family did not want to undergo operation and discharged. Six months later he was transferred again to our hospital by ambulance because of jaundice and disturbance of consciousness. He died of septic shock with DIC due to acute suppurative cholangitis five days after readmission. Multiple intrahepatic gallstones were confirmed by autopsy.