気管支胆管瘻の1例  [in Japanese] Bronchobiliary Fistula  [in Japanese]

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Abstract

57歳女性. 先天梅毒を認める. 以前より, 感冒症状出現時に黄色漿液性喀痰を喀出していた. 今回, 湿性咳嗽, 発熱を主訴として入院した. 入院時, 多発性気管支肺炎像を認めると同時に右中下葉の含気の低下, 胆石胆嚢炎, 麻痺性イレウスを合併していた. 意識レベルの低下認めることより, 誤嚥性肺炎を考え, 抗生剤を投与するも改善せず, 黄色漿液性胆汁様喀痰の喀出が持続した. 気管支鏡により, 右底幹より胆汁の持続的流出を認め, 気管支胆管瘻と診断した. 瘻孔閉鎖目的にて緊急開腹術を施行し, 肝右葉の著明な萎縮と肝左葉の腫大, 肝右葉と横隔膜の癒着, 感染胆汁を含む腫大した胆嚢, 大血管, 胆管の偏位, 脾腫が認められた. 術中のTチューブ造影にて, 右肝内胆管と肺の右底幹枝間に気管支胆管瘻が確認されたが, 緊急手術後の肝腎機能低下により二期手術を行い得ず, 気道, 胆道系の感染と肝腎不全にて死亡した. 本症は, 本邦では極めて稀とされており, 貴重な症例と考えられ報告した.

A 57-year-old woman with congenital syphilis had a productive cough, fever, cholecystolithiasis, and paralytic ileus. She had a 30-year history of recurrent bronchitis accompanied by yellowish serous sputum. A chest radiograph showed bilateral infiltrates resulting from aspiration pneumonia, and a reduction in volume of the right middle and right lower lobes. After recovering from paralytic ileus, she still had fever and biliptysis. Bronchoscopy revealed bile filling the right basal bronchi. Emergency laparotomy and throacotomy revealed a gall stone, splenomegaly, marked atrophy of the right lobe of the liver, and adhesion between the right pleura and the diaphragm. A T-tube cholangiogram showed that the right hepatic duct communicated with the right basal bronchus. Despite ligation of the right hepatic duct, biliptysis continued. The patient died due to rapidly progressing hepatorenal failure.<br>Syphilis gummosa due to congenital syphilis was suspected as a cause of the bronchobiliary fistula, but was not confirmed pathologically. The surgical specimen showed only nonspecific fibrosis with calcification. Bronchobiliary fistula is rare in Japan; we know of only 6 other reported cases.

Journal

  • The Japanese journal of thoracic diseases

    The Japanese journal of thoracic diseases 34(6), 689-693, 1996-06-25

    The Japanese Respiratory Society

References:  11

Cited by:  2

Codes

  • NII Article ID (NAID)
    10008110188
  • NII NACSIS-CAT ID (NCID)
    AN00187758
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03011542
  • Data Source
    CJP  CJPref  J-STAGE 
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