腹腔鏡下胆囊摘出術施行中に発生した広範な皮下気腫および縦隔気腫の1例

Extensive subcutaneous emphysema and mediastinal emphysema during laparoscopic cholecystectomy : report of a case

◆要旨：患者は81歳，男性．2008年10月から悪心，嘔吐が出現し，当院の消化器内科を受診した．急性胆囊炎と診断され，保存的加療を施行された．同年11月，当科にて胆石症に対し腹腔鏡下胆囊摘出術を施行した．術中，頸部から胸腹部に及ぶ広範な皮下気腫が発生したため，気腹操作を中止し，気胸のないこと，呼吸循環状態が安定していることを確認した後，吊り上げ式にて腹腔鏡下胆囊摘出術を続行した．術後早急に皮下気腫は消失し，退院となった．腹腔鏡下胆囊摘出術における皮下気腫の発生頻度は約0.39％と報告されているが，広範囲に及ぶ皮下気腫ならびに縦隔気腫の併発は稀であり，文献的考察を加え報告する．

　We report a rare case of combined subcutaneous and mediastinal emphysema, together with some bibliographical comments. This is the case of an 81-year-old male, who presented with nausea and vomiting in the department of gastroenterology of our hospital in October 2008. He was diagnosed with acute cholecystitis and was managed with conservative therapy. Laparoscopic cholecystectomy was performed for cholelithiasis on the following month. Instillation of gas in the peritoneum was discontinued because of the appearance of extensive subcutaneous emphysema in the abdominal, thoracic, and cervical regions during surgery. Gasless laparoscopic cholecystectomy was performed after the absence of pneumothorax and stability of the respiration and circulation were confirmed. Subcutaneous emphysema rapidly disappeared after surgery. Afterwards, he was discharged from the hospital. The occurrence rate of subcutaneous emphysema during laparoscopic cholecystectomy is approximately 0.39%.