腹腔鏡下に切除した肝鎌状間膜膿瘍の1例

Laparoscopic resection of the falciform ligament abscess

◆要旨：症例は76歳，男性．上腹部痛を主訴に受診，腹部造影CT検査で肝鎌状間膜膿瘍と診断され，抗生剤加療と経皮的ドレナージを施行した．培養でKlebsiella pneumoniaeを認めた．膿瘍は縮小し，ドレナージ5日後にドレーンを抜去し，13日後に退院した．しかし退院116日後に肝鎌状間膜膿瘍が再燃したため，再ドレナージで膿瘍を縮小させ根治手術を行った．手術は腹腔鏡下に膿瘍腔の完全切除を行い，膿瘍腔周囲の肝臓および腹壁の合併切除も行った．肝鎌状間膜膿瘍の報告例はそのほとんどが肝円索を膿瘍の首座とする．本例は，肝円索に膿瘍を伴わず，肝鎌状間膜内にのみ限局する大変稀な症例であり，文献的考察を加え報告する．

　A 76-year-old male presented to our hospital with upper abdominal pain. A contrast enhanced computed tomography demonstrated abscess in falciform ligament. The patient underwent antibiotic therapy and a percutaneous abscess drainage. Cultures from the specimen grew Klebsiella pneumoniae. After the abscess became smaller, the drainage tube was removed and he was discharged. 116 days after discharge, the abscess in the falciform ligament recurred with upper abdominal pain. Re-drainage, following complete resection of the falciform ligament abscess, and combined partial liver resection and abdominal wall resection was performed laparoscopically. A falciform ligament abscess is rare disease with only 30 cases reported. Among them, the majority are abscess in round ligament of liver. However, the abscess was located only in the falciform ligament, not in the round ligament in this case.