急性腹症で発症した肝円索膿瘍に対して緊急手術を施行した1例

A case of emergency surgery for hepatic circumscribed abscess presenting as acute abdomen

◆要旨：症例は67歳，男性で，急な上腹部痛を主訴に受診した．発熱と血液検査上炎症反応の高度上昇を認め，腹部CT検査では胆囊腫大と総胆管拡張，肝円索肥厚，周囲の脂肪織濃度上昇を認め，胆囊炎から炎症波及した肝円索膿瘍の疑いで緊急手術の方針となった．術中所見では胆囊や周囲臓器には明らかな異常は認めず，肝円索の著明な肥厚と白苔の付着，膿汁の流出を認めた．腹腔鏡下肝円索切除と胆囊摘出術を施行し，症状は軽快した．肝円索膿瘍は急性腹症として発症することのある重要な疾患でありながら，発生頻度が低く報告例も少ない．自験例の原因としては，無症状の先天性胆道拡張症に伴う胆道系感染からの炎症波及や高度の歯周感染症との関連が考えられる．

　A 67-year-old man presented to our hospital with a complaint of sudden upper abdominal pain. An abdominal CT scan showed an enlarged gallbladder, dilated common bile duct, thickened ligamentum teres hepatic, and increased fatty tissue density in the surrounding area. Intraoperative findings showed no obvious abnormality in the gallbladder or surrounding organs, but marked thickening of the ligamentum teres hepatic and abscess formation. Laparoscopic resection of the ligamentum teres hepatic and cholecystectomy were performed, and the patient recovered. Abscess of ligamentum teres hepatic is an important but rare disease with few reported cases. The cause in our patient may have been related to inflammatory spillover from biliary tract infection due to asymptomatic congenital biliary dilatation or severe periodontal infection.