Narkhede Rajvilas Anil, Bada Vijaykumar C, Kona Lakshmi Kumari
Department of Surgical Gastroenterology, Global Hospital, Lakdi Ka Pul, Hyderabad, 500004 India.
Shemba, Nandura, Buldana, Maharashtra 440103 India.
Indian J Surg. 2017 Feb;79(1):51-57. doi: 10.1007/s12262-016-1575-x. Epub 2016 Dec 28.
Gallstone ileus is a diagnosis of rarity, and a proximal site of obstruction in a young patient is even rare. Of the three cases in our experience, we found two cases of gallstone ileus (GSI) with typical epidemiology and presentation, one had combination of multiple rare associations. We report such a case, suspected to have gallstone ileus on ultrasound and confirmed diagnosis on computed tomography. Presence of biliary-enteric fistula, old age, and obstructive features, as in typical cases, was a bigger asset for diagnosis, but it was difficult to entertain diagnosis of GSI in young girl in absence of a demonstrable biliary-enteric fistula, with uncommon association of choledochal cyst and sickle cell disease. A very surprising finding, dilated major papilla, could however explain the pathogenesis which has also been reported in the past. Although differential opinions regarding management exist, we decided to follow two-stage surgery as our institute protocol. A minimal access approach has been immensely helpful in accurate diagnosis, and expedative management with early recovery has been proven in the past studies which we agreed with our experience.
胆石性肠梗阻是一种罕见的诊断，而年轻患者出现近端梗阻的情况更为罕见。在我们所经历的三例病例中，我们发现两例胆石性肠梗阻（GSI）具有典型的流行病学特征和临床表现，其中一例合并了多种罕见的关联情况。我们报告这样一例病例，超声检查怀疑为胆石性肠梗阻，计算机断层扫描确诊。与典型病例一样，存在胆肠瘘、老年以及梗阻特征对诊断有很大帮助，但在没有可证实的胆肠瘘、合并胆总管囊肿和镰状细胞病这种不常见关联的年轻女孩中，很难考虑胆石性肠梗阻的诊断。然而，一个非常令人惊讶的发现——乳头肿大，却可以解释其发病机制，过去也有相关报道。尽管对于治疗存在不同意见，但我们决定按照我们研究所的方案进行两阶段手术。微创入路在准确诊断方面非常有帮助，过去的研究已经证明其能实现快速治疗并使患者早期康复，我们的经验也证实了这一点。
