胆嚢胃瘻による胆石イレウスの発症を契機に発見された胆嚢癌の1例  [in Japanese] A case of gallstone ileus caused by cholecystogastric fistula with carcinoma of the gallbladder  [in Japanese]

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Author(s)

    • 蓮見 桂三 HASUMI Keizo
    • 東海大学医学部消化器内科 Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine
    • 鈴木 孝良 SUZUKI Takayoshi
    • 東海大学医学部消化器内科 Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine
    • 齊藤 真 SAITOH Shin
    • 東海大学医学部消化器内科 Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine
    • 峯 徹哉 MINE Tetsuya
    • 東海大学医学部消化器内科 Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine

Abstract

症例は71歳,男性.平成13年7月7日,悪心嘔吐にて当院受診.腹部単純X線写真上,右側腹部に2.5cm大の類円形石灰化像とniveau像を認めた.腹部CTで石灰化像は小腸内に位置し, 口側腸管は著明に拡張していた. 胆嚢は萎縮し内部にはpneumobiliaを認め,それは胃前庭部と交通していた.以上より胆嚢胃瘻を形成後発症した胆石イレウスと診断した. イレウスは保存的治療後, 結石が第3 病日に便中に自然排石され解除した.狭心症内服治療中であり,その時点では外科的治療は選択せず自然閉鎖を期待し,中心静脈栄養にて経過観察したが,約1カ月後の内視鏡的逆行性胆管造影で内胆汁瘻は閉鎖していないことが確認され,胆嚢摘出術,瘻孔閉鎖術を施行した.摘出した胆嚢の病理所見上,胆嚢癌の合併を認めた. 内胆汁瘻は逆行性胆管炎, 胆嚢癌合併などの危険もあるため, 自然閉鎖しない時は積極的に根治術を施行することが望ましいと考えられた.

A 71-years old man was admitted with nausea and vomiting on July 7,2001. Abdominal X-ray films showed air-fluid level in the small bowel and a calcified object sized 2.5 cm in diameter in the right flank. CT scan of the abdomen revealed the calcified object in the small bowel associated with proximal dilatation. CT also demonstrated the contracted gallbladder, pneumobilia, and a fistula between the gallbladder and the gastric antrum. Based on these findings, it was thought that the patient developed cholecystogastric fistula and small bowel obstruction due to a gallstone. He was treated conservatively and obstruction resolved after passage of the gallstone into stool on the third hospital day. He was initially treated with TPN. However, the cholecystogastric fistula remained open one month later. Therefore, he underwent cholecystectomy and fistulectomy. Pathological examination of the surgical specimen revealed cancer partly in the gallbladder. Because a biliary fistula could develop ascending cholangitis and gallbladder cancer, surgical repair should be considered if it does not close spontaneously.

Journal

  • Tando

    Tando 16(1), 43-49, 2002-03-25

    Japan Biliary Association

References:  17

Cited by:  6

Codes

  • NII Article ID (NAID)
    10008363373
  • NII NACSIS-CAT ID (NCID)
    AN10062001
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    09140077
  • Data Source
    CJP  CJPref  J-STAGE 
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