胆管結腸瘻を合併した胆嚢欠損症の1例

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  • Congenital Absence of the Gallbladder Associated with a Choledocho-Colic Fistula

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We report a case of congenital absence of gallbladder associated with a bile duct-colic fistula. A 67-year-old man with bouts of fever around 39°C was given a diagnosis of internal biliary fistula, because an abdominal CT scan showed liver abscess and pneumobilia, and the contrast medium in ERCP was leaked from the bile duct to the transverse colon. No diagnostic imaging method was able to show the gallbladder. Peroral cholangioscopy after endoscopic sphincterotomy and lithotripsy for choledocholithiases demonstrated no malignant findings but the inflammatory changes of the bile duct mucosa. Colonoscopy showed granulation at a fistula, but did not suggest the cause of the fistula. Laparotomy showed the transverse colon located in the recess of the liver where formation S4/5 was insufficient and adhered strongly to hepatic hilum. The structure of gallbladder was not seen. The biliary side of the fistula was the right side of the confluence of the bilateral hepatic ducts. Congenital absence of gallbladder is known to be associated with choledocholithiasis. In the present case, cholangitis due to choledocholithiases is thought to have caused the internal biliary fistula to the adjacent transverse colon.

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