竹内 和男^{1, 2}

Kazuo TAKEUCHI^{1, 2}

¹虎の門病院消化器科, ²沖中記念成人病研究所

¹Division of Gastroenterology,Toranomon Hospital, ²Okinaka Memorial Institute for Medical Research

キーワード : ultrasonography, calcium bilirubinate stone, β-glucuronidase, gallstone formation, post-gastrectomic cholecystitis

A 48-years old male was gastrectomized for advanced gastric cancer with reconstruction by Billroth I method. 　
Two months after operation, first attack of cholecystitis occurred. During the attack, ultrasonography revealed gravity-dependent low level echoes without back-shadowing, but no stone echoes were noted in the gallbladder. Subsequent ultrasonographic examination (USE) during the two other episodes of acute cholecystitis showed one oval shaped stone on the IInd USE (6 months after operation) and two stone echoes on the IIIrd USE (8 months after operation). However, no low level echoes as noted on the first USE were noted. 　
At cholecystectomy, there were two calcium bilirubinate stones in the gallbladder. 　
The serial USE suggests that initially recognized low level echoes without back-shadowing changed to calcium bilirubinate gallstones during several attacks of acute cholecystitis and the USE findings support the Maki's hypothesis on mechanism of coagulation and solidification of calcium bilirubinate gallstone.