第5巻 2009年2月　第1号

■症例報告

術前に診断しえた胆嚢捻転症の1例
山初　和也, 吉田　寛, 真々田　裕宏, 谷合　信彦, 有馬　保生, 横室　茂樹, 相本　隆幸, 中村　慶春, 田尻　孝
日本医科大学大学院医学研究科臓器病態制御外科学

A Case Report of Acute Torsion of the Gallbladder Diagnosed Preoperatively
Kazuya Yamahatsu, Hiroshi Yoshida, Yasuhiro Mamada, Nobuhiko Taniai, Yasuo Arima, Shigeki Yokomuro, Takayuki Aimoto, Yoshiharu Nakamura and Takashi Tajiri
Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School

Torsion of the gallbladder is a rare condition that most commonly affects the elderly. This condition is rarely diagnosed preoperatively despite advances in diagnostic imaging. We report a case of torsion of the gall bladder diagnosed preoperatively. An 81-year-old woman presented with right upper quadrant pain. Initial laboratory tests revealed elevation of the white blood cell count to 15,900/μL (normal, 4,000 to 8,000/μL) and mild liver dysfunction. Ultrasonography and computed tomography revealed swelling of the gall bladder with increased wall thickness, but neither examination showed any gallstones. Percutaneous transhepatic gall bladder drainage was performed, and bloody bile juice was obtained. Cholangiography via the drainage catheter of the gall bladder and endoscopic retrograde cholangiography revealed smooth tapering of the neck of the gall bladder. We diagnosed acute torsion of gallbladder and brought the patient to the operating theatre for laparoscopic cholecystectomy. Intraoperatively, we observed that the gallbladder had undergone complete torsion and appeared gangrenous. Routine cholecystectomy was then performed, and the patient recovered without incident.

日医大医会誌 2009; 5(1), 57-60

Key words
gall bladder, torsion, preoperative diagnosis, laparoscopic cholecystectomy

Correspondence to
Kazuya Yamahatsu, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
E-mail：yama-8@nms.ac.jp

受付：2008年7月31日　受理：2008年8月29日