Carlos M Nuño-Guzmán, José Arróniz-Jáuregui, Pável A Moreno-Pérez, Édgar A Chávez-Solís, Nereida Esparza-Arias, Cuauhtémoc I Hernández-González, Department of General Surgery, Antiguo Hospital Civil de Guadalajara "Fray Antonio Alcalde", Calle Hospital No.278, Sector Hidalgo. C.P. 44280, Guadalajara, Jalisco, Mexico.
World J Gastrointest Surg. 2010 May 27;2(5):172-6. doi: 10.4240/wjgs.v2.i5.172.
Gallstone ileus, an uncommon complication of cholelithiasis, is described as a mechanical intestinal obstruction due to impaction of one or more large gallstones within the gastrointestinal tract. The clinical presentation is variable, depending on the site of obstruction, manifested as acute, intermittent or chronic episodes. A 51-year-old female patient was referred to our hospital with 3 events of intestinal obstruction during the previous 7 d. At admission, there were clinical signs of intestinal obstruction; abdominal film demonstrated dilated bowel loops, air-fluid levels and a vague image of a stone in the inferior left quadrant. Once stabilized, a laparotomy was performed. Surgical findings were distention of the jejunum and ileum proximal to a palpable stone in the ileum as well as gallstones and a cholecystoduodenal fistula in the gallbladder. An enterolithotomy, repair of the cholecystoduodenal fistula and cholecystectomy were performed. The postoperative course was uneventful. There is no uniform surgical procedure for this disease. When the patient is too ill or when biliary surgery is not advisable, an enterolithotomy is the best option. The one-stage procedure should be the offered to adequately stabilized patients when local and general conditions, such as good cardiorespiratory and metabolic reserve permit a more prolonged surgical procedure.
胆囊结石性肠梗阻是一种少见的胆石病并发症，是由于一个或多个大的胆囊结石嵌顿在胃肠道内而导致的机械性肠梗阻。其临床表现具有多样性，取决于梗阻部位，可表现为急性、间歇性或慢性发作。一名 51 岁女性患者因过去 7 天内发生 3 次肠梗阻而被转至我院。入院时，患者有肠梗阻的临床体征；腹部 X 线片显示肠袢扩张、气液平面和左下腹模糊的结石影。一旦病情稳定，即进行剖腹探查。手术发现回肠和空肠近端扩张，在回肠可触及结石，胆囊内有胆石和胆囊十二指肠瘘。进行了肠石切开术、胆囊十二指肠瘘修补术和胆囊切除术。术后过程顺利。对于这种疾病，没有统一的手术程序。当患者病情太重或不适合进行胆道手术时，肠石切开术是最佳选择。当局部和全身情况允许（如良好的心肺和代谢储备），能够进行更长时间的手术时，应向充分稳定的患者提供一期手术。
