Journal Article 急性胆嚢炎に伴う胆嚢仮性動脈瘤出血を来した1例
A case of cystic artery pseudoaneurysm acompanied with acute cholecystitis.
キュウセイ タンノウエン ニ トモナウ タンノウ カセイ ドウミャクリュウ シュッケツ オ キタシタ 1レイ

久保, 秀文  ,  長岡, 知里  ,  宮原, 誠  ,  大野, 高嗣  ,  齋藤, 満  ,  安井, 正泰

64 ( 4 )  , pp.263 - 270 , 2015-11-01 , 山口大学医学会
胆嚢仮性動脈瘤はまれな疾患であり,その報告はわが国では13例のみと少ない.われわれは急性胆嚢炎に併存した胆嚢仮性動脈瘤の1例を経験したので報告する.症例は59歳男性,2015年1月下血を来して近医を受診した.胆嚢炎と貧血を指摘され精査目的で当院へ紹介入院となった.腹部CTで胆嚢頚部に約3cm径の境界明瞭な嚢胞病変が指摘され,強い造影効果を示していた.胆嚢動脈瘤に起因する胆嚢出血が下血を起こしたものと診断した.輸血や抗生剤投与などの保存的加療を行っていたが,入院後5日目に総ビリルビン値が3.4mg/dlへ上昇した.胆道内の血腫による閉塞性黄疸を疑い胆道内へpig tailドレナージチューブを挿入した.その後速やかに総ビリルビン値は正常化した.入院より8日目に開腹胆嚢摘出術を施行した.病理組織学的所見で胆嚢炎と線維性の被膜を有した血腫が観察され,高度の胆嚢炎に伴う胆嚢仮性動脈瘤破裂と診断した.胆嚢仮性動脈瘤は稀ではあるが吐下血の患者では念頭に置くべき疾患である.
Cystic Artery Pseudoaneurysm of the Gallbladder(CAPG)is rare disease, and Japanese journals reported only 13 cases in the past. We report the case of a 59-year-old Japanese man, complicated CAPG with acute cholecystitis on January 2015. The patient was referred by his private doctor because of experienced melena, and he was diagnosed cholecystitis and anemia. An abdominal computed tomography(CT)scan clearly revealed a cystic mass about 3.0cm in diameter in the neck of gallbladder. We diagnosed that his melena was cause of bleeding from the gallbladder with CAPG. During the hospitalization, he received blood transfusions and antibiotics, while after 5days, his total bilirubin level was up to 3.4mg/dl. We suspected obstructive icterus resulting from hematoma in biliary tract, and inserted a pigtail catheter to biliary tract. Since then, his total bilirubin level returned rapidly to normal. On the 8th day from hospitalization, we operated cholecystectomy. Pathological examination revealed cholecystitis and fibrotic hematoma. We diagnosed CAPG derived from severe cholecystitis. Although CAPG is rare disease, it should be considered in cases with hematemesis and melena.

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