A Case of Localized Suppurative Cholangitis in the Lateral Segment of the Liver after Operation for Gallstone Ileus

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  • 胆石イレウス術後に肝外側区域に限局した化膿性胆管炎を併発した1例

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Abstract

We report a case of localized suppurative cholangitis in the lateral segment of the liver after operation for gallstone ileus. A man in his fifties was admitted to our hospital with ileus. Abdominal computed tomography showed a ring-shaped calcification measuring 31mm in diameter in the small intestine, to the left of the navel, and expansion of the oral aspect of the small intestine relative to this. A fistula was recognized between the atrophic gallbladder and duodenum. Emergency surgery was undertaken under the diagnosis of gallstone ileus. We removed a calculus stuck in the jejunum, and sequentially performed cholecystectomy and closure of the fistula. Localized suppurative cholangitis in the lateral segment of the liver occurred postoperatively. The cholangitis improved with PTCD, however, bile duct stenosis was recognized at the junction of B2B3. This stenotic segment was expanded with a balloon. It was suspected that the localized suppurative cholangitis in the lateral segment of the liver was induced by retrograde transmission of infection through the cholecystoduodenal fistula or hematogenous infection because of the ileus, in addition to the bile duct stenosis at the junction of B2B3.

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