Hajjar Roy, Létourneau Audrey, Henri Margaret, Heyen Françoise, Latulippe Jean-François, Poirier Madeleine, Tremblay Jean-François, Trépanier Jean-Sébastien, Bendavid Yves
Université de Montréal, Programme de Chirurgie Générale, Hôpital Maisonneuve-Rosemont, 5415 Boul de l'Assomption, Montréal QC.
Hôpital Maisonneuve-Rosemont, Service de Chirurgie Colorectale, 5415 Boul de l'Assomption, Montréal, Quebec, Canada.
J Surg Case Rep. 2018 Oct 16;2018(10):rjy278. doi: 10.1093/jscr/rjy278. eCollection 2018 Oct.
A cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis with cholecystitis. Cholecystocolonic fistulas (CCFs) account for 8-26.5% of all CEFs. CCFs can cause colonic bleeding, obstruction or perforation, with such complications being mainly reported in the narrower sigmoid colon. Colonic biliary ileus, or obstruction due to the colonic gallstone impaction, is extremely rare in the proximal colon and its best management is yet to be elucidated. We present the case of a 73-year-old male patient with multiple comorbidities and previous abdominal surgeries who presented with hematochezia and intestinal obstructive symptoms. Imaging revealed a giant 5 × 7 cm gallstone in the proximal transverse colon. Laparotomy and stone extraction via colotomy were performed. Complicated proximal colonic gallstones are exceedingly rare with several operative and non-operative treatments already described. A time-saving surgery in a patient with serious comorbidities is reasonable when compared to a more extensive procedure including enterolithotomy, cholecystecomy and fistula closure.
胆囊肠瘘（CEF）是胆石症合并胆囊炎的一种罕见并发症。胆囊结肠瘘（CCF）占所有CEF的8 - 26.5%。CCF可导致结肠出血、梗阻或穿孔，此类并发症主要见于较狭窄的乙状结肠。结肠胆石性肠梗阻，即因结肠内胆石嵌顿所致的梗阻，在近端结肠极为罕见，其最佳治疗方法尚待阐明。我们报告一例73岁男性患者，有多种合并症且既往有腹部手术史，出现便血和肠梗阻症状。影像学检查显示在近端横结肠有一枚5×7 cm的巨大胆石。行剖腹探查术并通过结肠切开取石。复杂的近端结肠胆石极为罕见，已有多种手术和非手术治疗方法的描述。与包括肠石切除术、胆囊切除术和瘘管闭合术等更广泛的手术相比，为合并严重疾病的患者进行节省时间的手术是合理的。
