胆石胆嚢炎,膵炎および脾動脈瘤を合併した成人肝鎌状間膜膿瘍の1例

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  • A CASE OF ABSCESS ON ADULT FALCIFORM LIGAMENT OF THE LIVER COMPLICATED WITH CHOLELITHIC CHOLECYSTITIS, PANCREATITIS AND SPLENIC ANEURYSM

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A rare case of hepatic falciform ligament tumor is reported. A 48-year-old male was admitted to the hospital because of right hypochondralgia. Ultrosonography and CT revealed cholelithiasis, enlargement of the pancreas and a tumor adjacent to the abdominal wall in the midline of the upper abdomen, extending to the umbilicus from the umbilical portion of the portal vein. Abdominal angiography revealed an aneurysm of the splenic artery. A diagnosis of cholelithiasis with cholesistitis, pancreatitis, tumor of the hepatic falciform ligament and splenic artery aneurysm was made, and surgery was performed. A tumor of hepatic falciform ligament was prominent at laparotomy. The upper edge was resected near the umbilical portion of the portal vein and the tumor was extirpated. The splenic artery aneurysm was then exposed and resected along with the remainder of the splenic artery. Reconstruction of the splenic artery was not attempted. The spleen exhibited no evidence of compromised blood flow by color changes after splenic artery interruption. The spleen was somewhat firm overall, with some surrounding adhesion, but no pseudocyst formation. There was no visible evidence of inflammation of the hepatoduodenal ligament or hepatic falciform ligament. Cholecystectomy was then performed. Greenish brown purulent fluid was noted within the resected tumor, from which coagulase negative Staphylococcus was cultured. Probable etiology was inferred to be extended inflammation from cholecystitis.

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