Département des maladies de l'appareil digestif, groupe hospitalier Paris-Saint-Joseph, 185, rue R.-Losserand, 75014 Paris, France.
J Visc Surg. 2012 Aug;149(4):e284-6. doi: 10.1016/j.jviscsurg.2012.02.001. Epub 2012 May 23.
This case report describes a 77-year-old male, who presented to the emergency room with symptoms of an acute proximal small bowel obstruction. Abdominal CT scan with multi-planar reconstructions led to the diagnosis of an intestinal obstruction due to impaction of a large gallstone in the second portion of the duodenum. The CT scan demonstrated a large cholecysto-duodenal fistula as the origin of the gallstone migration. Surgical treatment consisted of milking the stone down beyond the ligament of Treitz, where it was removed through a jejunal enterotomy. The postoperative course was uncomplicated. No attempt was made to repair the choledocho-duodenal fistula at the initial intervention nor subsequently, and there have been no complications due to the fistula over 36 months of follow-up observation.
本病例报告描述了一位 77 岁男性，因急性近端小肠梗阻症状到急诊就诊。腹部 CT 扫描加多平面重建导致诊断为十二指肠第二段结石嵌顿引起的肠梗阻。CT 扫描显示大的胆囊-十二指肠瘘是结石迁移的来源。手术治疗包括将石头从Treitz 韧带下方挤下，通过空肠肠切开术取出。术后过程顺利。在初次干预时，也没有尝试修复胆管-十二指肠瘘，随后也没有，在 36 个月的随访观察中，由于瘘管没有出现任何并发症。
