Gürleyik G, Gürleyik E
Abant Izzet Baysal Universitesi Tip Fakültesi Genel Cerrahi Anabilim Dali, Düzce.
Ulus Travma Derg. 2001 Jan;7(1):32-4.
Gallstone ileus is an uncommon intestinal obstruction with unexpectedly high mortality. It is not easy to diagnose this uncommon disease preoperatively. The aim of our study is to establish some simple criteria supporting the suspicion of gallstone ileus in patients with small intestine obstruction. We retrospectively analysed hospital records of 8 patients with gallstone ileus and 1230 cases of mechanical intestinal obstruction, excluding incarcerated external hernias. Gallstones were the cause of occlusion in 0.9% (8/886) of patients with small bowel obstruction. All our 8 patients were women with an average age of 74 years. Gallstone ileus was diagnosed in 18% of elderly (+70 years) women with small intestine obstruction. This rate raised to 36% in this group of elderly women if previous abdominal operations that would produce adhesion were excluded. Previous ultrasonographic examinations had demonstrated gallstones in 5 (62%) patients. Only one patient (12.5%) was diagnosed preoperatively with plain X ray film demonstrating gas in the biliary tract. The obstruction was treated with enterolithotomy. Cholecystectomy was performed in two (25%) patients. The mortality was 25% in early postoperative period. Advanced age, female sex, and positive patient's history of known gallstone in the gallbladder have appeared as strong criteria. Gallstone ileus is a common cause of intestinal obstruction in elderly women with no previous abdominal operations and without incarcerated external hernia. Pneumobilia is more common radiological finding to establish the diagnosis of gallstone ileus in these patients.
胆石性肠梗阻是一种罕见的肠梗阻，死亡率出奇地高。术前诊断这种罕见疾病并不容易。我们研究的目的是建立一些简单的标准，以支持对小肠梗阻患者胆石性肠梗阻的怀疑。我们回顾性分析了8例胆石性肠梗阻患者和1230例机械性肠梗阻患者的医院记录，不包括嵌顿性外疝。胆石是小肠梗阻患者中0.9%（8/886）的梗阻原因。我们的8例患者均为女性，平均年龄74岁。在老年（≥70岁）小肠梗阻女性患者中，18%被诊断为胆石性肠梗阻。如果排除会产生粘连的既往腹部手术，该组老年女性的这一比例升至36%。既往超声检查显示5例（62%）患者有胆结石。术前仅1例患者（12.5%）通过腹部平片显示胆道积气被诊断。梗阻采用肠石切除术治疗。2例（25%）患者行胆囊切除术。术后早期死亡率为25%。高龄、女性以及患者有胆囊结石病史已成为重要的诊断标准。胆石性肠梗阻是无既往腹部手术且无嵌顿性外疝的老年女性肠梗阻的常见原因。胆道积气是这些患者诊断胆石性肠梗阻更常见的影像学表现。
