Chan Angela W, Sabaratnam Rathi M, Pillay Yagan
103 Hospital Drive, Royal University Hospital, Department of Surgery, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada.
Department of Pathology and Laboratory Medicine, Victoria Hospital- 1200 24th St W, Prince Albert, SK, S6V 4N9, Canada.
Int J Surg Case Rep. 2020;72:429-432. doi: 10.1016/j.ijscr.2020.06.028. Epub 2020 Jun 11.
Gallstones are present in 10-15% of North Americans, but only 20% become symptomatic. This case report describes a patient with a 7.5 cm gallstone detected incidentally while being investigated for cardiac pathology. This is the first report in the English literature of a stone this size that has remained clinically asymptomatic. This work is reported in line with the SCARE criteria.
The patient was a 71-year-old Indigenous Canadian male, with atrial fibrillation. His cardiologist ordered a CT scan of his chest, which incidentally identified a large gallstone. He was referred to surgery for asymptomatic cholelithiasis. An uncomplicated laparoscopic cholecystectomy was performed. Final pathology showed a 7.5 cm gallstone with features of chronic cholecystitis.
The patient's ethnicity and gallstone size placed him at increased risk for gallbladder cancer, gallstone fistulization and perforation. We reviewed the literature for asymptomatic patients who may benefit from cholecystectomy: transplant recipients and those with hemolytic disorders. Laparoscopic cholecystectomy is not currently indicated in diabetics and bariatric surgery patients.
This case report shows that there are asymptomatic patients with massive gallstones. A review of their history, risk factors for malignancy and future gallstone related complications must be carefully weighed and discussed prior to deciding on surgical versus expectant management.
北美有10% - 15%的人患有胆结石，但只有20%会出现症状。本病例报告描述了一名在因心脏疾病接受检查时偶然发现一枚7.5厘米胆结石的患者。这是英文文献中首次报道如此大小的结石且临床上无症状的病例。本报告按照SCARE标准撰写。
患者为一名71岁的加拿大原住民男性，患有心房颤动。他的心脏病专家为他安排了胸部CT扫描，偶然发现了一枚大的胆结石。他因无症状胆结石被转诊至外科。进行了一次无并发症的腹腔镜胆囊切除术。最终病理显示为一枚7.5厘米的胆结石，伴有慢性胆囊炎特征。
患者的种族和胆结石大小使他患胆囊癌、胆结石瘘管形成和穿孔的风险增加。我们查阅了文献，了解可能从胆囊切除术中获益的无症状患者：器官移植受者和患有溶血性疾病的患者。目前糖尿病患者和减肥手术患者不建议进行腹腔镜胆囊切除术。
本病例报告表明存在无症状的巨大胆结石患者。在决定手术治疗还是观察等待之前，必须仔细权衡并讨论他们的病史、恶性肿瘤风险因素以及未来与胆结石相关的并发症。
