Halleran Devin R, Halleran David R
College of Medicine Upstate Medical University, Syracuse, NY 13210, United States.
College of Medicine Upstate Medical University, Syracuse, NY 13210, United States.
Int J Surg Case Rep. 2014;5(12):1295-8. doi: 10.1016/j.ijscr.2014.11.058. Epub 2014 Nov 21.
Herein we present the case of an 86-year-old woman with gallstone perforation of the sigmoid colon.
An 86-year-old woman with known cholelithiasis presented to our office with one week of abdominal pain and nausea. X-rays taken at presentation demonstrated pneumobilia, and CT scan showed a 3.5cm gallstone in the sigmoid colon. Medical management was unsuccessful in passing the stone, and a colonoscopy on day 4 was unsuccessful in incorporating the stone. Subsequent clinical deterioration prompted a laparotomy, where a perforation was discovered. A Hartmann's procedure was performed and the patient recovered after a complicated post-operative course.
Gallstone ileus is an uncommon, but medically important, cause of bowel obstruction. This presentation is considered a surgical emergency and thus prompt identification and removal is essential. Obstructions tend to occur in either the stomach or along the various segments of the small intestine but have been reported in the colon as well.
In cases of gallstones that manage to pass into the large intestine, it is prudent to attempt conservative measures for passage. Failure to do so should raise suspicion of a possible stricture, either benign or malignant, preventing its evacuation. Earlier surgical intervention should be considered in these cases.
在此我们报告一例86岁女性乙状结肠胆结石穿孔的病例。
一名患有胆结石的86岁女性因腹痛和恶心一周前来就诊。就诊时拍摄的X线片显示有气腹，CT扫描显示乙状结肠有一枚3.5厘米的胆结石。药物治疗未能排出结石，第4天进行的结肠镜检查也未能取出结石。随后的临床病情恶化促使进行剖腹手术，术中发现了穿孔。实施了哈特曼手术，患者在经历复杂的术后过程后康复。
胆结石性肠梗阻是一种罕见但在医学上很重要的肠梗阻原因。这种情况被视为外科急症，因此及时识别和清除至关重要。梗阻往往发生在胃或小肠的各个节段，但也有在结肠发生的报道。
对于进入大肠的胆结石病例，尝试采取保守措施促其排出是明智的。若未能成功，应怀疑可能存在良性或恶性狭窄阻碍其排出。在这些情况下应考虑早期手术干预。
