Pratas N, Salvador D, Costa C S
Department of General Surgery, North Alentejo Local Unit E.P.E., Portugal.
Department of General Surgery, North Alentejo Local Unit E.P.E., Portugal.
Int J Surg Case Rep. 2020;77:107-110. doi: 10.1016/j.ijscr.2020.10.133. Epub 2020 Nov 2.
Gallstone ileus is an infrequent complication of biliary disease that produces a mechanical intestinal obstruction. It is caused by a gallstone passing through a bilio-digestive communication, usually a cholecystoduodenal fistula. The presence of neoplasms can decrease the bowel lumen size and may cause the gallstone to impact at the narrowing site.
In this report, we present a unique case of gallstone ileus due to a gallstone impacted in a cecum tumor, causing obstruction at the level of the ileocecal valve. The patient needed an urgent right hemicolectomy to solve both his problems. The gallbladder and the enterobiliary fistula remained in situ.
The clinical presentation is not always straightforward and sometimes the diagnosis is only made by imaging, mostly resorting to an abdominal CT. The mainstay of management is surgical relief of the gastrointestinal obstruction, with the surgical method being based on what is found intra-operatively and according to the patient general condition.
Although a rare disease, gallstone ileus should be suspected in elderly patients with intestinal obstruction and a previous history of biliary problems, keeping in mind that other conditions may be present and can alter the surgical treatment of choice.
胆石性肠梗阻是胆道疾病的一种罕见并发症，可导致机械性肠梗阻。它是由胆结石通过胆-消化道瘘管引起的，通常是胆囊十二指肠瘘。肿瘤的存在会减小肠腔大小，并可能导致胆结石在狭窄部位嵌顿。
在本报告中，我们呈现了一例独特的胆石性肠梗阻病例，病因是胆结石嵌顿于盲肠肿瘤，导致回盲瓣水平梗阻。患者需要紧急行右半结肠切除术以解决这两个问题。胆囊和胆肠瘘管保留原位。
临床表现并不总是一目了然，有时仅通过影像学检查才能做出诊断，主要依靠腹部CT。治疗的主要方法是手术解除胃肠道梗阻，手术方式根据术中所见及患者一般情况而定。
尽管胆石性肠梗阻是一种罕见疾病，但对于有肠梗阻且既往有胆道疾病史的老年患者应怀疑此病，同时要记住可能存在其他情况并可能改变首选的手术治疗方式。
