吉本 和子¹, 須井 修², 梶 雅子³, 手束 一博³, 岩本 誠司², 森 宏仁³, 小田 修治³

Kazuko YOSHIMOTO¹, Osamu SUI², Masako KAJI³, Kazuhiro TEZUKA³, Seiji IWAMOTO², Hirohito MORI³, Syuuji ODA³

¹独立行政法人国立病院機構善通寺病院臨床検査科, ²独立行政法人国立病院機構善通寺病院放射線科, ³独立行政法人国立病院機構善通寺病院消化器内科

¹Clinical Laboratory, National Hospital Organization Zentsuji National Hospital, ²Department of Radiology, National Hospital Organization Zentsuji National Hospital, ³Department of Gastroenterology, National Hospital Organization Zentsuji National Hospital

キーワード : acute cholecystitis, ethanol injection therapy, infected liver cyst, <i>klebsiella pneumoniae</i>, ultrasonography

症例は42歳, 女性. 発熱・腹痛を主訴に当院内科外来を受診した. 右季肋部に圧痛があり, 血液検査では肝胆道系酵素の上昇とWBC 13000 /μl, CRP 17.4 mg/dlの強い炎症所見を認めた. 当初, 壁肥厚しdebrisを伴う嚢胞性病変 (8 cm)が胆嚢床に一致して存在していたため, 腹部単純CT・超音波検査共に急性胆嚢炎と診断された. 抗生物質投与を行ったが発熱, 炎症所見は改善されず, 経皮経肝ドレナージを施行した. ドレナージ液は乳白色膿状で細菌培養検査よりKlebsiella pneumoniaeが分離された. 炎症所見はドレナージ後改善傾向を示した. ドレナージ後に施行したMRCPで正常な胆嚢に接して嚢胞性病変が見られるようになり感染性肝嚢胞の診断に至った. 嚢胞造影検査でわずかに末梢の胆管が造影されたが中枢側胆道系との連続性は見られなかった. ドレナージチューブの閉鎖に伴い嚢胞の増大傾向があったためエタノール注入術を施行した. 約2ヵ月後感染を起こした嚢胞は消失した.

Awoman aged 42 years was hospitalized with fever and abdominal pain. The patient had hypochondrial tenderness on the right side. Blood examination showed increasing hepatobiliary system enzyme concentration and strong inflammatory findings: WBC, 13000 /亮l and CRP, 17.4 mg/dl. Abdominal CT and ultrasonography showed a wall-thickening cystic lesion 8 cm in diameter. The lesion was accompanied by debris and was compressing the gallbladder. We proposed a diagnosis of acute cholecystitis. Percutaneous transhepatic drainage was carried out when the inflammation failed to respond to administration of antibiotics. The drained fluid was milky white and purulent, and Klebsiella pneumoniae was isolated in the cultured fluid. Inflammatory findings gradually disappeared after the fluid was drained. Magnetic resonance cholangiopancreatography (MRCP) after drainage revealed the normal gallbladder near the cystic lesion and led us to a diagnosis of infected liver cyst. The cyst became large by closing the drainage tube. Cystography showed the fine bile duct but there was no obvious connection to main bile duct. We administered ethanol injection therapy, and the infected liver cyst had disappeared 2 months later.