Vyčítal O, Liška V, Geiger J, Třeška V
Rozhl Chir. 2016 Feb;95(2):83-6.
Biliary ileus represents only 14% of mechanical obstructions of the gastrointestinal tract. However, the rate of non-strangulated small bowel obstructions reaches as much as 25% in patients over 65 years of age. Usually, a pressure necrosis is created by a large gallstone that passes through the developed biliodigestive fistula, subsequently obturating the gastrointestinal tract.
35 patients underwent a surgical procedure at the Department of Surgery, Teaching Hospital Pilsen for biliary ileus from January 1, 2000 to January 31, 2015. Mean age was 79 years (median 78 years; min. 58 years; max. 92 years). Aerobilia was visible in abdominal X-ray scans in 7 cases (26%) of 27 acquired images. Preoperatively, colonoscopy was done 2 times and esophagogastroduodenoscopy 9 times. Regarding surgical procedures, enterolithotomy was done in 21 cases, extraction of the gallstone from gastrotomy was done 3 times, small bowel resection 7 times, Hartmann resection 1 time, resection of ileoascendentoanastomosis 1 time, and extraction of the gallstone from duodenotomy with duodenojejunoanastomosis and cholecystectomy was done in 1 case. Ileotransversoanastomosis was performed in 1 case. Postoperative 30-day mortality was 14.3%. Postoperative morbidity according Clavien-Dindo was 22.8% for grade 1, 5.7% for grade 2, 11.5% for grade 3, and 11.5% for grade 4. A recurrence was observed in 8.8%. Primary treatment of the fistula and cholecystectomy were done in 1 case.
The indication of primary biliodigestive fistula treatment always depends on the general condition of the patient and on the local finding in the gallbladder area. Residual fistula increases the risk of reccurence, but primary treatment is associated with higher mortality. It is also important to duly revise the entire bowel to avoid an early reccurence due to multiple gallstones.
biliary ileus diagnosis treatment.
胆石性肠梗阻仅占胃肠道机械性梗阻的14%。然而，在65岁以上的患者中，非绞窄性小肠梗阻的发生率高达25%。通常，一枚大的胆结石通过已形成的胆肠瘘时会造成压迫性坏死，随后阻塞胃肠道。
2000年1月1日至2015年1月31日期间，35例患者因胆石性肠梗阻在比尔森教学医院外科接受了手术治疗。平均年龄为79岁（中位数78岁；最小58岁；最大92岁）。在27例获得的腹部X线扫描图像中，7例（26%）可见气腹。术前，进行了2次结肠镜检查和9次食管胃十二指肠镜检查。关于手术方式，21例行肠切开取石术，3例行经胃切开取石术，7例行小肠切除术，1例行哈特曼切除术，1例行回肠升结肠吻合口切除术，1例行经十二指肠切开取石术并十二指肠空肠吻合术及胆囊切除术。1例行回肠横结肠吻合术。术后30天死亡率为14.3%。根据Clavien-Dindo分级，术后1级并发症发生率为22.8%，2级为5.7%，3级为11.5%，4级为11.5%。复发率为8.8%。1例行瘘管一期治疗和胆囊切除术。
胆肠瘘一期治疗的指征始终取决于患者的一般状况和胆囊区域的局部情况。残留瘘管会增加复发风险，但一期治疗会增加死亡率。对整个肠道进行适当检查也很重要，以避免因多发胆结石导致早期复发。
胆石性肠梗阻；诊断；治疗
