Salah-Eldin A A, Ibrahim M A, Alapati R, Muslah S, Schubert T T, Schuman B M
Division of Gastroenterology, Henry Ford Hospital, Detroit, MI 48202.
Henry Ford Hosp Med J. 1990;38(1):52-4.
Gallstones are usually silent. Less commonly, patients with cholelithiasis develop symptoms and/or complications; biliary fistula occurs in 3% to 5% of the cases. When a large stone is passed and occludes the duodenum, gastric outlet obstruction (the Bouveret syndrome) may result. In reported cases, the stones are usually larger than 2.5 cm. The usual presenting symptoms are those of bowel obstruction: abdominal pain, nausea, and vomiting. Less commonly, the patients experience melena and, rarely, hematemesis. We describe a patient who had the largest stone reported to cause hematemesis rather than bowel obstruction and to be diagnosed endoscopically. The 5 X 4 X 3 cm stone was extracted surgically. Endoscopic diagnosis and extraction of stones up to 3 cm in size has been reported, avoiding the need for surgery.
胆结石通常没有症状。较少见的是，胆石症患者会出现症状和/或并发症；胆瘘发生在3%至5%的病例中。当一颗大结石通过并阻塞十二指肠时，可能会导致胃出口梗阻（布韦雷综合征）。在报告的病例中，结石通常大于2.5厘米。常见的症状是肠梗阻的症状：腹痛、恶心和呕吐。较少见的是，患者会出现黑便，很少出现呕血。我们描述了一名患者，其结石据报道是导致呕血而非肠梗阻且经内镜诊断的最大结石。这块5×4×3厘米的结石通过手术取出。已有报道称可通过内镜诊断并取出直径达3厘米的结石，从而避免手术。
