Chou Jen-Wei, Hsu Chang-Hu, Liao Kuan-Fu, Lai Hsueh-Chou, Cheng Ken-Sheng, Peng Cheng-Yuan, Yang Mei-Due, Chen Yung-Fang
Division of Gastroenterology, Department of Internal Medicine, China Medical University Hospital, No.2, Yuh-Der Road, North District, Taichung 40447, Taiwan, China.
World J Gastroenterol. 2007 Feb 28;13(8):1295-8. doi: 10.3748/wjg.v13.i8.1295.
Gallstone ileus is a rare disease and accounts for 1%-4% of all cases of mechanical intestinal obstruction. It usually occurs in the elderly with a female predominance and may result in a high mortality rate. Its diagnosis is difficult and early diagnosis could reduce the mortality. Surgery remains the mainstay of treatment. We report two cases of gallstone ileus. The first was a 78-year old woman who had a 2-d history of vomiting and epigastralgia. Plain abdominal film suggested small bowel obstruction clinically attributed to adhesions. Later on, gallstone ileus was diagnosed by abdominal computed tomography (CT) based on the presence of pneumobilia, bowel obstruction, and an ectopic stone within the jejunum. She underwent emergent laparotomy with a one-stage procedure of enterolithotomy, cholecystectomy and fistula repair. The second case was a 76-year old man with a 1-wk history of epigastralgia. Plain abdominal film showed two round calcified stones in the right upper quadrant. Fistulography confirmed the presence of a cholecystoduodenal fistula and gallstone ileus was also diagnosed by abdominal CT. We attempted to remove the stones endoscopically, but failed leading to an emergent laparotomy and the same one-stage procedure as for the first case. The postoperative courses of the two cases were uneventful. Inspired by these 2 cases we reviewed the literature on the cause, diagnosis and treatment of gallstone ileus.
胆结石性肠梗阻是一种罕见疾病，占所有机械性肠梗阻病例的1% - 4%。它通常发生于老年人，女性居多，且可能导致较高的死亡率。其诊断困难，早期诊断可降低死亡率。手术仍是主要的治疗方法。我们报告两例胆结石性肠梗阻病例。第一例是一位78岁女性，有2天呕吐和上腹痛病史。腹部平片提示小肠梗阻，临床归因于粘连。后来，通过腹部计算机断层扫描（CT）诊断为胆结石性肠梗阻，依据是空肠内存在气胆、肠梗阻及异位结石。她接受了急诊剖腹手术，采用一期肠石切除术、胆囊切除术和瘘管修复术。第二例是一位76岁男性，有1周上腹痛病史。腹部平片显示右上腹有两颗圆形钙化结石。瘘管造影证实存在胆囊十二指肠瘘，腹部CT也诊断为胆结石性肠梗阻。我们试图通过内镜取出结石，但未成功，导致急诊剖腹手术，手术方式与第一例相同，也是一期手术。两例患者术后病程均顺利。受这两例病例启发，我们回顾了有关胆结石性肠梗阻病因、诊断和治疗的文献。
