Özer Nazmi
Department of General Surgery, Adana City Training and Research Hospital, Adana, Turkey.
Int J Surg Case Rep. 2019;61:153-156. doi: 10.1016/j.ijscr.2019.06.063. Epub 2019 Jul 11.
Gallstone ileus (GSİ) is a rare complication of cholelithiasis (gallbladderstone), which may lead to obstruction of the small intestine. Particularly, computerized tomographic (CT) imaging method and special findings in these images help diagnosing of gallstone ileus. Treatment of this disease is surgery, surgery involves cholecystectomy + fistula repair + enterolitotomy, but it is controversial to perform cholecystectomy with enterolitotomy and fistula repair in the same session.
A 75-year-old male patient consulted to the emergency department with the complaints of nausea and vomiting. In the examinations of the patient, bilienteric fistula and gallstones that impacted in the jejunum leading to obstruction were observed in abdominal CT images of the patient who has ileus. The patient was evaluated as gallstone ileus. In addition, on tomographic images significant Forchet sign and Rigler's triad images were viewed which were pathognomonic for gallstone ileus and did not have images as clear as in our case in the literature search. Laparotomy was performed on the patient due to the fact that he was elderly and the duration of anesthesia was wanted to be kept short and stone was extracted by enterolitotomy. Cholecystectomy and fistula repair were left for another session because of gallbladder and surrounding tissues were edematous. The patient was discharged with full recovery on the 6th post-operative day.
DISCUSSION-CONCLUSION: As well as this disease is a rare cause of mechanical bowel obstruction, it is mostly seen in elderly patients. The most sensitive and specific imaging method in diagnosis is contrast-enhanced abdominal computerized tomography. In the tomographic images, especially the Rigler's triad, Forchet sign and Petren sign are pathognomonic for gallstone ileus.
胆石性肠梗阻（GSİ）是胆石症（胆囊结石）的一种罕见并发症，可导致小肠梗阻。特别是，计算机断层扫描（CT）成像方法以及这些图像中的特殊表现有助于诊断胆石性肠梗阻。该疾病的治疗方法是手术，手术包括胆囊切除术 + 瘘管修复 + 肠切开取石术，但在同一次手术中进行胆囊切除术与肠切开取石术和瘘管修复存在争议。
一名75岁男性患者因恶心和呕吐症状到急诊科就诊。在对该患者的检查中，在肠梗阻患者的腹部CT图像中观察到胆肠瘘和嵌顿在空肠导致梗阻的胆结石。该患者被诊断为胆石性肠梗阻。此外，在断层图像上还观察到了典型的福尔谢征和里格勒三联征图像，这些图像对胆石性肠梗阻具有诊断意义，在文献检索中没有像我们病例中这样清晰的图像。由于患者年事已高且希望缩短麻醉时间，对该患者进行了剖腹手术，并通过肠切开取石术取出结石。由于胆囊及周围组织水肿，胆囊切除术和瘘管修复留待另一期进行。患者术后第6天完全康复出院。
讨论 - 结论：除了这种疾病是机械性肠梗阻的罕见原因外，它多见于老年患者。诊断中最敏感和特异的成像方法是腹部增强计算机断层扫描。在断层图像中，尤其是里格勒三联征、福尔谢征和彼得伦征对胆石性肠梗阻具有诊断意义。
