Sahsamanis Georgios, Maltezos Konstantinos, Dimas Panagiotis, Tassos Alexandros, Mouchasiris Christos
1st Department of Surgery, 401 Army General Hospital of Athens, Greece.
1st Department of Surgery, 401 Army General Hospital of Athens, Greece.
Int J Surg Case Rep. 2016;26:193-6. doi: 10.1016/j.ijscr.2016.07.050. Epub 2016 Jul 30.
Gallstone bowel obstruction is a rare form of mechanical ileus usually presenting in elderly patients, and is associated with chronic or acute cholecystitis episodes.
We present the case of an 80year old female with abdominal pain, inability to defecate and recurrent episodes of diarrhea for the past 8 months. CT examination uncovered a cholecystoduodenal fistula along with gas in the gall bladder and the presence of a ≥2cm gallstone inside the small bowel lumen causing obstruction. Patient was admitted to the operating room, where a 3.2cm gallstone was located in the terminal ileus. A rupture was found in the antimesenteric part of a discolored small bowel segment, approximately 60cm from the ileocaecal valve, through which the gallstone was recovered. The bowel regained its peristalsis, and the rupture was debrided and sutured. Patient was discharged uneventfully on the 6th postoperative day.
Gallstone ileus is caused due to the impaction of a gallstone inside the bowel lumen. It usually passes through a fistula connecting the gallstone with the gastrointestinal tract. It can present with nonspecific or acute abdominal symptoms. CT usually confirms the diagnosis, while there are a number of treatment options; conservative, minimal invasive and surgical. Our patient was successfully relieved of the obstruction through recovery of the gallstone using open surgery, with no repair of the fistula.
Although rare, gallstones must be suspected as a possible cause of bowel obstruction, especially in elderly patients reporting biliary symptoms.
胆结石性肠梗阻是机械性肠梗阻的一种罕见形式，通常发生于老年患者，且与慢性或急性胆囊炎发作有关。
我们报告一例80岁女性患者，在过去8个月中出现腹痛、无法排便及反复腹泻。CT检查发现胆囊十二指肠瘘，胆囊内有气体，小肠腔内有一枚≥2cm的胆结石导致梗阻。患者被送入手术室，在回肠末端发现一枚3.2cm的胆结石。在距回盲瓣约60cm处，一段变色小肠的系膜对侧部分发现一处破裂口，胆结石由此取出。肠道恢复蠕动，对破裂口进行清创缝合。患者术后第6天顺利出院。
胆结石性肠梗阻是由于胆结石在肠腔内嵌顿所致。它通常通过连接胆结石与胃肠道的瘘管进入肠道。可表现为非特异性或急性腹部症状。CT通常可确诊，治疗方法有多种，包括保守治疗、微创治疗和手术治疗。我们的患者通过开放手术取出胆结石成功解除梗阻，未对瘘管进行修复。
尽管罕见，但胆结石必须被怀疑为肠梗阻的可能病因，尤其是在有胆道症状的老年患者中。
