壊疽性胆囊炎を合併した結節性多発動脈炎の1例

Abstract

A 52-year-old male was diagnosed in 1983 as having polyarteritis nodosa on the basis of Raynaud's phenomenon, purpura of the lower limbs, leukocytosis, proteinuria, and histological findings of the kidney, skin, and muscle. The patient had since been administered corticosteroid but was admitted due to abdominal pain and fever in late March, 1984. Tenderness and muscular defence were noted in the right abdomen. Abdominal CT and ultrasonography demonstrated a very large cyst-like image with an invaginated structure. The swelling of the right abdomen was considered to be gallbladder abscess and was resected, but it proved to be peritoneal abscess. In the pus, the gallbladder that dropped spontaneously at the neck was observed. The histological diagnosis was gangrenous cholecystitis, and the condition was complicated by fibrinoid degeneration of small-sized vascular lesions and perivascular neutrophil infiltration. The cause of the peritoneal abscess in this patient is considered to have been necrosis and perforation of the gallbladder, which had been rendered ischemic due to cholecystic arteritis.