DIC–CTが有用であった鈍的外傷による総胆管完全断裂の1例(A case of complete transection of the common bile duct due to blunt abdominal trauma in which DIC–CT was useful for diagnosis)

要旨 症例は19歳の女性。軽自動車運転中に受傷した。腹部造影CTで少量の腹腔内貯留液を認め，肝・膵損傷が疑われた。全身状態は安定しており，保存的加療とした。入院後，症状は徐々に改善し，第7病日より経口摂取を開始した。その後腹部膨満が増強し，第10病日の腹部CTにて腹水が著明に増量していた。腹水穿刺では胆汁様であり，DIC–CTにて下部胆管損傷が確認されたため，手術を施行した。術中所見から総胆管断裂と診断し，胆管空腸吻合を施行した。その後第26病日に軽快退院となった。鈍的腹部外傷による総胆管損傷は，特異的な所見に乏しく，診断が遅れることがある。本症例では，DIC–CTが診断に有効であった。 ABSTRACT Common bile duct injury due to blunt abdominal trauma is rare, and early diagnosis is difficult. We report a case of complete disruption of the common bile duct diagnosed by drip infusion cholecystocholangiography with computed tomography (DIC–CT). A 19–year–old woman had a traffic accident while driving. Abdominal contrast–enhanced CT scan showed liver and pancreatic damage with a small amount of fluid accumulation in the abdomen. She had a spinal rod because of previous scoliosis surgery. Her vital signs and clinical condition were stable, so we carefully observed the patient nonoperatively. After admission, she looked to be improving and started eating on day 7. However, on day 10, she complained of abdominal distention. Abdominal CT scan confirmed the presence of large amount of ascites. Abdominal fluid test revealed bile spillage, and DIC–CT revealed injury to the lower bile duct. During the operation, we detected transection of the common bile duct, and we performed choledochojejunostomy. The patient recovered well after the operation and left the hospital on day 26. Common bile duct injury due to blunt abdominal trauma is rare, and its early diagnosis can be difficult. DIC–CT can be helpful in the diagnosis.