[胃肠道出血与谵妄：胆结石性肠梗阻诊断中的挑战：一例病例报告及文献综述]
[Gastrointestinal bleeding and delirium, challenges in the diagnosis of gallstone ileus: A case report and review of literature].
作者信息
Aguilar-Espinosa Francisco, Gálvez-Romero José Luis, Falfán-Moreno Jesús, Guerrero-Martínez Gustavo Adolfo, Vargas-Solís Facundo
机构信息
Servicio de Cirugía General, Hospital Regional «Puebla», Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE, Puebla, México.
Servicio de Inmunoalergología, Hospital Regional «Puebla», Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE, Puebla, México.
出版信息
Cir Cir. 2017 Dec;85 Suppl 1:53-57. doi: 10.1016/j.circir.2016.11.003. Epub 2017 Jan 19.
BACKGROUND
Gallstone ileus is a non-strangulated mechanical obstruction of the small bowel or colon as a result of the passage of gallstones through a biliary enteric fistula. It is a rare complication of cholelithiasis, affects patients over 65 years, and the disease occurs predominantly in females. Preoperative diagnosis is difficult due to the lack of specific signs and symptoms in elderly patients with multiple comorbidities.
CLINICAL CASE
A 93-year-old female presenting with a one-week history of upper gastrointestinal bleeding, electrolyte imbalance and community- acquired pneumonia pneumonia. During her prolonged hospital stay she presented an intestinal obstruction. The diagnosis of gallstone ileus was made by CT scan. Despite surgical treatment, she died due to late diagnosis.
CONCLUSIONS
Gallstone ileus is a rare pathology, difficulty in diagnosis prolongs hospital stay, which directly influences mortality.
背景
胆结石性肠梗阻是由于胆结石通过胆肠瘘进入小肠或结肠而导致的非绞窄性机械性肠梗阻。它是胆石症的一种罕见并发症，影响65岁以上的患者，且该疾病主要发生于女性。由于老年患者合并多种疾病且缺乏特异性体征和症状，术前诊断困难。
临床病例
一名93岁女性，有一周的上消化道出血、电解质失衡及社区获得性肺炎病史。在其长期住院期间出现肠梗阻。通过CT扫描诊断为胆结石性肠梗阻。尽管进行了手术治疗，但她因诊断延误而死亡。
结论
胆结石性肠梗阻是一种罕见的疾病，诊断困难会延长住院时间，这直接影响死亡率。
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