Al-Abbasi Ghaith, Alhilfy Ali Adil, Al-Jasim Ameer
University of Baghdad, Baghdad, Iraq.
Surg J (N Y). 2021 May 25;7(2):e54-e58. doi: 10.1055/s-0041-1725160. eCollection 2021 Apr.
Gallstone ileus is a very infrequent complication of cholelithiasis in which single or multiple stones pass through an abnormal fistula to the lumen of the intestine leading to a true mechanical obstruction. We are reporting a case of a female who developed intestinal obstruction due to gallstones during the coronavirus disease 2019 (COVID-19) outbreak and was managed urgently surgically in a low-settings hospital. An 85-year-old white female with 40 years history of gallstone disease, hypertension, and type-2 diabetes presented to the accidents and emergency unit with upper central crampy abdominal pain for 5 days associated with green color vomiting and absolute constipation. On examination, she was barely stable, dehydrated, had a distended abdomen, and guarding in the epigastric region. Her electrolytes were disturbed and had elevated serum creatinine and blood urea. Imaging studies confirmed gallstone ileus. Management was surgical despite the lack of facilities and equipment including COVID-19 personal protective equipment. Despite being an infrequent complication, gallstone ileus might present at the most unexpected time and in the least equipped hospital where the surgeon's suspicion, risk stratification, and improvisation by utilizing what is available are the keys for successful management and saving lives.
胆石性肠梗阻是胆石症一种非常罕见的并发症，单个或多个结石通过异常瘘管进入肠腔，导致真正的机械性梗阻。我们报告一例女性患者，在2019冠状病毒病（COVID-19）疫情期间因胆结石发生肠梗阻，并在一家条件有限的医院接受了紧急手术治疗。
一名85岁白人女性，有40年胆石症、高血压和2型糖尿病病史，因中上腹绞痛5天，伴有绿色呕吐物和完全便秘，就诊于急症室。检查时，她情况勉强稳定，脱水，腹部膨隆，上腹部有压痛。她的电解质紊乱，血清肌酐和血尿素升高。影像学检查确诊为胆石性肠梗阻。尽管缺乏包括COVID-19个人防护装备在内的设施和设备，仍进行了手术治疗。
尽管胆石性肠梗阻是一种罕见的并发症，但它可能在最意想不到的时间出现，而且是在设备最简陋的医院。外科医生的怀疑、风险分层以及利用现有资源进行的临时应对，是成功治疗和挽救生命的关键。
