Department of Pathophysiology and Transplantation-Department of General Surgery, Università degli Studi di Milano-Istituto Clinico Sant'Ambrogio, via Faravelli 16, 20149, Milan, Italy,
J Gastrointest Surg. 2013 Dec;17(12):2162-5. doi: 10.1007/s11605-013-2290-6. Epub 2013 Jul 30.
Gallstone ileus is an uncommon disease and accounts for 1-4 % of all cases of mechanical intestinal obstruction. The physiopathology is related to the presence of a bilioenteric fistula.
We report two cases of gallstone ileus in patients operated on biliointestinal bypass for morbid obesity. The anastomosis of the gallbladder to the proximal end of the bypassed jejunum allowed the transit of gallstones in the excluded ileum and its impaction in anti-reflux valvular system.
Preoperative exams were unable to solve the diagnostic query, and the diagnosis was achieved only at laparotomy. One-stage combined enterolithotomy and cholecystectomy were performed.
The two patients had an uneventful recovery. To our knowledge, this is the first report of gallstone ileus after biliointestinal bypass.
胆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%。其病理生理学与胆肠瘘的存在有关。
我们报告了两例胆石性肠梗阻病例，这些患者因病态肥胖而行胆肠旁路手术。胆囊与旁路空肠近端的吻合允许结石通过被排除的回肠并嵌顿在抗反流瓣膜系统中。
术前检查无法解决诊断问题，仅在剖腹手术时才做出诊断。我们实施了一期联合肠石切除术和胆囊切除术。
两名患者均恢复顺利。据我们所知，这是首例胆肠旁路术后胆石性肠梗阻的报告。
