A Case of Cholecystogastric Fistula.
Copyright policy ) Akira IGARASHI; Takashi ITO;
A Case of Cholecystogastric Fistula.
特発性内胆汁瘻の中でも稀な胆嚢胃瘻を経験したので報告する.症例は, 68歳,女性で嘔気を主訴に近医を受診し,内服薬にて加療されていた.その後,右季肋部に圧痛をきたすようになったため当院紹介となった.腹部造影CT検査にて胆嚢の腫大と胆石を認めたため胆石症による胆嚢炎の診断にて入院の上,保存的加療を開始した.胃内視鏡検査を施行したところ前庭部の前壁に比較的境界明瞭で中心部に浅い陥凹を伴った隆起性病変を認め,浅い陥凹部から白色の膿様の流出がみられた.内視鏡検査に加え, MRI, MRCP, ERCP,胃十二指腸造影検査にて胆石症および胆嚢炎を伴う胆嚢胃瘻と診断し,手術を施行した.手術所見では,胆嚢は強固に胃前庭部に癒着し胆嚢と胃との瘻孔を認めた.胆嚢摘出,瘻孔閉鎖を施行した.術後は経過順調であった.
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