Das Niloy, Plummer Nicholas R, Raja Hassan, Vashist Ashok
Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston, UK
Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston, UK.
J Surg Case Rep. 2014 Jul 6;2014(7):rju042. doi: 10.1093/jscr/rju042.
We present a rare case of large bowel obstruction secondary to colonic gallstones in a frail nonagenarian. Uniquely, the stone was impacted in the descending colon-sigmoid junction, in the absence of underlying bowel pathology distal to the stone. In light of worsening pain and distension after failed endoscopic treatment, the patient was treated with an emergency laparotomy. After an on-table dilemma, a proximal defunctioning loop colostomy was fashioned and the stone left in situ, with the eventual fate of the stone currently undecided. We also discuss alternative treatment options and explain the thought processes that lead to our decision.
我们报告了一例罕见的病例，一名体弱的九旬老人因结肠胆结石继发大肠梗阻。独特的是，结石嵌顿在降结肠-乙状结肠交界处，结石远端不存在潜在的肠道病变。鉴于内镜治疗失败后疼痛和腹胀加剧，该患者接受了急诊剖腹手术。经过术中的两难抉择，做了一个近端失功性袢式结肠造口术，结石留在原位，结石的最终命运目前尚未确定。我们还讨论了其他治疗选择，并解释了做出我们决定的思维过程。
