外傷性胆嚢破裂の1例 A CASE REPORT OF TRAUMATIC RUPTURE OF THE GALLBLADDER

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外傷による胆嚢損傷は比較的稀であるとされており,腹部鈍的外傷のうち胆嚢損傷の占める割合は2%前後と報告されている.本邦では検索しえた範囲で45例の報告がみられた.今回われわれは,胆嚢損傷の1例を経験したので報告する.症例は82歳,男性.自宅にて転倒し右季肋部を強打,その後5日経過して他院受診し肝挫傷,右血胸が疑われ当院を紹介された. CTにて,肝周囲に液体の貯留を認め,腹腔穿刺で胆汁が引けたため,胆汁性腹膜炎の診断にて緊急手術を施行した.開腹すると,肝下面を覆うように大網が癒着しており,それを剥離すると胆汁流出が見られた.胆嚢を挙上すると胆嚢後面より胆汁の流出が見られた.胆嚢破裂と診断し,胆嚢摘出術を施行した.摘出した胆嚢の体部に3.5mmの穿孔を認め,その付近には肝組織が付着し肝床部よりの胆嚢剥離が考えられた.本症例は外傷後5日間経過したのち当院来院し,診断治療を行ったが,合併損傷もなく,術後経過良好であった.

Gallbladder injuries due to abdominal trauma are rarely observed clinically because of the anatomical protection by the liver, kidney, costal arch and intestine, and so the incidence of the injuries is about 2% of all blunt abdominal traumas. To our knowledge, a total of 45 cases have been reported in Japan. We exprienced a case of solitary gallbladder injury caused by a blunt abdominal trauma.<br> An 82-year-old man, who fell down and got a bruise on the right hypochondrium at home 5 days before, was referred to the hospital with a suspicion of hepatic contusion and right hemothorax. Abdominal CT scan showed a low density fluid retention around the liver and a puncture of ascites revealed the presence of bile juice.<br> Emergency operation was performed with a diagnosis of biliary peritonitis. Open laparotomy, the gallbladder was dissected traumatically from its bed and a perforation was seen on the body of the gallbladder. The patient was diagnosed as having acute biliary peritonitis secondary to ruptured gallbladder. There were no other injuries, and a cholecystectomy with abdominal drainage was performed. On the resected body the gallbladder, a 3.5mm perforation was present and it was demonstrated that the gallbladder might be dissected from the gallbladder bed. Although the treatment was started 5 days after the iujury in this patient, the postoperative course was uneventful.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 62(3), 767-771, 2001-03-25

    Japan Surgical Association

参考文献:  22件中 1-22件 を表示

被引用文献:  3件中 1-3件 を表示

各種コード

  • NII論文ID(NAID)
    10008389041
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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