Caselitz M, Gebel M, Bleck J, Boozari B, Prokop M, Oldhafer K, Richter N, Manns M
Abteilung für Gastroenterologie und Hepatologie, Medizinische Hochschule Hannover.
Ultraschall Med. 1999 Apr;20(2):78-80. doi: 10.1055/s-1999-14239.
We report on a case of an atypically located gallstone ileus as a rare complication of cholecystolithiasis. A 61-year old lady with a history of diabetes type II and nephrolitiasis presented with abdominal pain lasting for 8 days and with vomiting and diarrhoea. Physical examination revealed a palpable tumour and pain in the left lower abdomen. An extensive elevation of blood sugar, CRP and leukocytosis was found. Initially X-ray of the abdomen and sonography showed signs of a subileus. Additionally a 5 x 2 cm mass with dorsal shadowing was detected by ultrasound. Gallbladder and the biliary system were normal. The sonographic suspicion of a gallstone ileus was confirmed by a subsequent CT scan. Under operation the gallstone was found in the distal Jejunum. A gallstone ileus must be included in the differential diagnosis of a tumour in the left lower abdomen. A tumour with dorsal shadowing and signs of a subileus may be the only sonographic findings of a gallstone ileus.
我们报告一例位置不典型的胆石性肠梗阻病例，这是胆囊结石病的一种罕见并发症。一名61岁女性，有II型糖尿病和肾结石病史，出现持续8天的腹痛，并伴有呕吐和腹泻。体格检查发现左下腹可触及肿物并有压痛。血糖、C反应蛋白显著升高，白细胞增多。最初的腹部X线检查和超声检查显示有不全肠梗阻的迹象。此外，超声检测到一个5×2厘米的伴有后方声影的肿物。胆囊和胆道系统正常。随后的CT扫描证实了超声对胆石性肠梗阻的怀疑。手术中在空肠远端发现了胆结石。左下腹肿瘤的鉴别诊断必须包括胆石性肠梗阻。伴有后方声影和不全肠梗阻迹象的肿瘤可能是胆石性肠梗阻唯一的超声表现。
