A CASE OF LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE EMPHYSEMATOUS CHOLECYSTITIS

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  • 腹腔鏡下胆嚢摘出術を施行した急性気腫性胆嚢炎の1例

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Abstract

Acute emphysematous cholecystitis is a relatively rare disease which causes a gangrenous inflammation by gas-forming bacteria. Abdominal imaging examinations show abnormal gas in the gallbladder lumen and pericholecystic space. We experienced such a case successfully treated by laparoscopic cholecystectomy. A 66-year-old man was admitted to the hospital because of a right hypochondralgia. Abdominal plain roentgenography and CT demonstrated a gas around the gallbladder and a niveau formation in the organ. The patient was diagnosed as having acute emphysematous cholecystitis, and emergency laparoscopic cholecystectomy was performed. The gallbladder was redbrown in color and covered with the gastrocolic omentum but was not perforated. There was no pus like ascites. During the operation we sucked the bile through a puncture of the gallbladder, and inserted a fifth trocar in right side of the umbilicus. These methods were found to be helpful for the protection of operative contaminations, or the enhancement of wide view. A Clostridium was identified cultivation of bile juice. The patient recovered without complication and was discharged from the hospital 8 days after the operation. Laparoscopic cholecystectomy appears to be possiblly carried out for acute emphysematous cholecystitis and be useful for QOL.

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