Pezzoli Alessandro, Maimone Antonella, Fusetti Nadia, Pizzo Elena
Department of Gastroenterology and Endoscopy Unit, Sant'Anna University Hospital, v. A. Moro 8 203, 44124, Cona, Ferrara, Italy.
Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E7HB, UK.
J Med Case Rep. 2015 Mar 2;9:15. doi: 10.1186/1752-1947-9-15.
The preoperative diagnosis of gallstone ileus is challenging due to the variability of its presentation, often resulting in late diagnosis. Controversy remains regarding the management of gallstone ileus; surgery is the standard treatment, but also less invasive approaches have proven to be successful. We present an unusual case of gallstone ileus and its conservative treatment.
We describe the case of a 49-year-old Caucasian woman with a bowel sub-occlusion, treated conservatively. The imaging technique (plain abdominal X-ray and computed tomography scan) led to a diagnosis of gallstones ileus. A surgical intervention was not performed. Instead, she underwent extracorporeal shock-wave lithotripsy to fragment the stones, mechanical intestinal dilatation for ileocolic stenosis and endoscopic removal of the gallstone. The presence of an apricot shell contributed to the bowel occlusion and was removed. The intervention was successful and without complications.
Given the variability of the gallstone ileus presentation, surgery could not be the only treatment for our patient. In our case report, we show that colonoscopy could be a non-invasive approach that allows for diagnosis and treatment at the same time. The available data do not show a higher rate of recurrent biliary disease in cases where this method has been used, therefore in select patients, a conservative treatment could be an effective solution.
由于胆石性肠梗阻的表现多样，术前诊断具有挑战性，常常导致诊断延迟。关于胆石性肠梗阻的治疗仍存在争议；手术是标准治疗方法，但一些侵入性较小的方法也已被证明是成功的。我们报告一例不寻常的胆石性肠梗阻病例及其保守治疗。
我们描述了一名49岁患有肠道不全梗阻的白种女性患者，接受了保守治疗。影像学检查（腹部平片和计算机断层扫描）确诊为胆石性肠梗阻。未进行手术干预。相反，她接受了体外冲击波碎石术以破碎结石、针对回结肠狭窄的机械性肠道扩张以及内镜下取出胆结石。一颗杏核导致了肠道梗阻，已将其取出。干预成功且无并发症。
鉴于胆石性肠梗阻表现的多样性，手术并非我们这位患者的唯一治疗方法。在我们的病例报告中，我们表明结肠镜检查可以是一种同时实现诊断和治疗的非侵入性方法。现有数据并未显示在使用该方法的病例中胆系疾病复发率更高，因此在某些患者中，保守治疗可能是一种有效的解决方案。
