Wang Li, Dong Ping, Zhang Yi, Tian Bole
Department of Hepato-Bilio-Pancreatic Surgery Department of Radiology and Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, P.R. China.
Medicine (Baltimore). 2017 Nov;96(45):e8541. doi: 10.1097/MD.0000000000008541.
Gallstone ileus is a rare complication of cholecystolithiasis. It has a female predominance and can result in high mortality rates.
A 71-year-old woman complaining of recurrent vomiting and vague epigastralgia for > 2 weeks presented to our department.
Based on her physical examination, laboratory test results and radiographic findings (the typical Rigler's triad), she was diagnosed with gallstone ileus caused by multiple ectopic stones.
After correction of electrolyte imbalances through parenteral nutrition and fluid management, the patient's condition improved and she underwent enterolithotomy. A 5.3-cm stone located 40 cm from the ligament of Treitz was extracted, and a second ectopic stone, not detected on any imaging modality, was found during laparotomy. Given her comorbidities and overall poor condition, cholecystectomy and fistula repair were not performed.
The patient gradually recovered postoperatively.
Clinical symptoms including epigastralgia with nausea and vomiting, and abdominal CT findings of Rigler's triad (ectopic gallstone, bowel obstruction, and pneumobilia) may lead to early diagnosis of gallstone ileus and enterolithotomy may be the preferred treatment for this condition in the elderly. Laparotomy should involve a systematic and meticulous search for the presence of additional ectopic enteric stones.
胆石性肠梗阻是胆囊结石的一种罕见并发症。它以女性居多，且可导致高死亡率。
一名71岁女性因反复呕吐和上腹部隐痛超过2周前来我院就诊。
根据体格检查、实验室检查结果及影像学表现（典型的里格勒三联征），她被诊断为多发异位结石所致的胆石性肠梗阻。
通过肠外营养和液体管理纠正电解质失衡后，患者病情改善，随后接受了肠石切除术。取出了一枚距屈氏韧带40厘米处的5.3厘米结石，且在剖腹手术中发现了另一枚术前任何影像学检查均未发现的异位结石。鉴于其合并症及整体状况较差，未进行胆囊切除术和瘘管修复术。
患者术后逐渐康复。
包括伴有恶心呕吐的上腹部疼痛等临床症状，以及腹部CT显示的里格勒三联征（异位胆结石、肠梗阻和气腹）可能有助于早期诊断胆石性肠梗阻，对于老年患者，肠石切除术可能是首选治疗方法。剖腹手术应系统、细致地探查是否存在其他异位肠石。
