Lee Hyun Gu, Hwang Shin, Joo Yo-Han, Cho Yu-Jeong, Choi Kyunghak
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Hepatobiliary Pancreat Surg. 2015 May;19(2):78-81. doi: 10.14701/kjhbps.2015.19.2.78. Epub 2015 May 31.
The diagnosis of gallstone ileus is occasionally challenging due to the variability of its presentation. We herein present a very rare case of gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after 10 years of bile duct cancer surgery. We describe the case of a 74-year-old Korean woman with obstructive jaundice, treated conservatively. She showed severely impaired liver function test and obstructive jaundice. The computed tomography (CT) scan led to a diagnosis of very rare type of gallstones ileus at the afferent jejunal loop. Since the clinical manifestation was improved, we decided to observe her closely. On the next follow-up CT scan, the gallstone disappeared with mild distension of the afferent bowel loop, implicating spontaneous passage of the gallstone. She recovered and returned to normal life after 10 days of initiation of clinical manifestations. We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size. The presence of narrow tract of intestine may facilitate the incidence of gallstone ileus. It appears to be the first report on this rare type of gallstone ileus inducing obstructive jaundice.
由于胆囊结石性肠梗阻的临床表现具有多样性，其诊断有时具有挑战性。我们在此报告一例非常罕见的胆囊结石性肠梗阻病例，该病例发生在胆管癌手术后10年的Roux-en-Y肝空肠吻合术输入袢，导致梗阻性黄疸。我们描述了一名74岁韩国女性梗阻性黄疸患者的病例，该患者接受了保守治疗。她的肝功能检查严重受损且伴有梗阻性黄疸。计算机断层扫描（CT）显示在输入空肠袢发现了一种非常罕见类型的胆囊结石性肠梗阻。由于临床表现有所改善，我们决定密切观察她。在下一次随访CT扫描时，胆囊结石消失，输入肠袢轻度扩张，提示胆囊结石自行排出。临床表现出现10天后，她康复并恢复了正常生活。我们推测胆囊结石可能通过肝空肠吻合术进入输入空肠袢，随后体积增大。肠道狭窄可能会促使胆囊结石性肠梗阻的发生。这似乎是关于这种罕见类型的胆囊结石性肠梗阻导致梗阻性黄疸的首例报告。
