복강경 담낭-우반결장절제술로 치료된 담낭결장루 1예
Laparoscopic Right Hemicolectomy and Cholecystectomy for a Cholecystocolic Fistula
정소영, 김진배, 정재필, 우지영, 조지웅, 이승진, 김병천,
소속 상세정보
정소영 ( Jung So-Young )
한림대학교 의과대학 강남성심병원 외과
김진배 ( Kim Jin-Bae )
한림대학교 의과대학 강남성심병원 소화기내과
정재필 ( Jung Jae-Pil )
한림대학교 의과대학 강남성심병원 외과
우지영 ( Woo Ji-Young )
한림대학교 의과대학 강남성심병원 영상의학과
조지웅 ( Cho Ji-Woong )
한림대학교 의과대학 강남성심병원 외과
이승진 ( Lee Seung-Jin )
한림대학교 의과대학 강남성심병원 외과
김병천 ( Kim Byung-Chun )
한림대학교 의과대학 강남성심병원 외과
KMID : 0356720090250040268
Abstract
A cholecystocolic fistula (CF) is an uncommon complication of the gallbladder and colonic disease. We report a case of a CF that was successfully managed by using a laparoscopic right hemicolectomy and cholecystectomy. A 49-yr-old woman was admitted to the Department of Internal Medicine because of intermittent and progressive right upper quadrant pain. She was obese (body mass index: 34 kg/m2) and had a previous history of three abdominal surgeries. She was diagnosed with a CF by using abdominal computed tomography. The fistula between the gallbladder and the hepatic flexure of the colon was also characterized by using technetium-99m diisopropyl iminodiacetic acid (99mTc-DISIDA) cholescintigraphy, a double-contrast Barium enema, and colonoscopy. Multiple polyps with severe inflammation were observed around the orifice of the fistula. Because of the risk of malignancy and appendicolith on CT, a laparoscopic en block excision of the gallbladder and the right colon following adhesiolysis was performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. This case shows that the laparoscopic combined resection is safe and effective in the experienced hands of the laparoscopic surgeon even though a CF has traditionally been considered as a contraindication to laparoscopic surgery. While the incidence of successful management of biliary-enteric fistulas through laparoscopic repair is increasing, this is the first report of a laparoscopic combined resection of a CF in an obese patient with severe intraabdominal adhesion.
키워드
복강경;담낭절제술;결장절제술;담도누공;장관누공
Laparoscopy;Cholecystectomy;Colectomy;Biliary fistula;Intestinal fistula
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