Farkas Nicholas, Kaur Vasha, Shanmuganandan Arun, Black John, Redon Chantal, Frampton Adam E, West Nicholas
Epsom and St Helier University Hospitals, Wrythe Lane, Carshalton, Sutton, London, SM5 1AA, United Kingdom.
Ann Med Surg (Lond). 2018 Jan 31;27:32-39. doi: 10.1016/j.amsu.2018.01.004. eCollection 2018 Mar.
Gallstone sigmoid ileus is a rare although serious complication of cholelithiasis resulting in large bowel obstruction. The condition accounts for 4% of all gallstone ileus patients. There are no recognized management guidelines currently. Management strategies range from minimally invasive endoscopy and lithotripsy to substantial surgery. We aim to identify trends when managing patients with gallstone sigmoid ileus to help improve outcomes.
Literature searches of EMBASE, Medline and by hand were conducted. All English language papers published from 2000 to 2017(Oct) were included. The terms 'gallstone', 'sigmoid', 'colon', 'ileus', 'coleus' and 'large bowel obstruction' were used.
38 papers included, male:female ratio was 8:30. Average age was 81.11 (SD ± 7.59). Average length of preceding symptoms was 5.31days (+/-SD3.16). 20/38 (59%) had diverticulosis. 89% of patients had significant comorbidities documented. 34/38 patients underwent computerized tomography. 31 stones were located within sigmoid colon, 4 at rectosigmoid junction and 2 within descending colon. Average impacted gallstone size was 4.14 cm (2.3-7 cm range). 23/38 (61%) patients' initial management was conservative or with endoscopy ± lithotripsy. Conservative management successfully treated 26% of patients. 28/38 (74%) patients ultimately underwent surgical intervention. 5/38 patients died post-operatively. Patients treated non-operatively had shorter hospital stays (4:12.3days) although not significant (p-value = 0.0056).
There is no management consensus from the literature. Current evidence highlights endoscopy and lithotripsy as practical firstline strategies. However, surgical intervention should not be delayed if non-operative measures fail or in emergency. Given the complexity of such patients, less invasive timesaving surgery appears practical, avoiding bowel resection and associated complications.
胆结石乙状结肠肠梗阻是胆石症一种罕见但严重的并发症，可导致大肠梗阻。这种情况占所有胆结石肠梗阻患者的4%。目前尚无公认的管理指南。管理策略从微创内镜检查和碎石术到大型手术不等。我们旨在确定管理胆结石乙状结肠肠梗阻患者时的趋势，以帮助改善治疗结果。
对EMBASE、Medline进行文献检索并手工检索。纳入2000年至2017年10月发表的所有英文论文。使用了“胆结石”“乙状结肠”“结肠”“肠梗阻”“胆石性肠梗阻”和“大肠梗阻”等术语。
纳入38篇论文，男女比例为8:30。平均年龄为81.11岁（标准差±7.59）。先前症状的平均时长为5.31天（±标准差3.16）。20/38（59%）患有憩室病。89%的患者有显著的合并症记录。34/38例患者接受了计算机断层扫描。31颗结石位于乙状结肠内，4颗位于直肠乙状结肠交界处，2颗位于降结肠内。结石嵌顿的平均大小为4.14厘米（范围2.3 - 7厘米）。23/38（61%）患者的初始治疗为保守治疗或内镜检查±碎石术。保守治疗成功治疗了26%的患者。28/38（74%）患者最终接受了手术干预。5/38例患者术后死亡。非手术治疗的患者住院时间较短（4:12.3天），但差异无统计学意义（p值 = 0.0056）。
文献中没有管理共识。当前证据表明内镜检查和碎石术是切实可行的一线策略。然而，如果非手术措施失败或在紧急情况下，不应延迟手术干预。鉴于此类患者的复杂性，采用创伤较小、节省时间的手术似乎是可行的，可避免肠切除及相关并发症。
