Shrestha Nischal, Mishra Aakash, Ghimire Roshan
Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
Int J Surg Case Rep. 2022 Mar;92:106820. doi: 10.1016/j.ijscr.2022.106820. Epub 2022 Feb 8.
Gallstone ileus is caused by an impaction of one or more gallstones within the gastrointestinal tract, leading to mechanical intestinal obstruction. It is a rare complication of cholelithiasis leading to the formation of a cholecystoenteric fistula and is associated with high mortality rates. We report a case of atypical subacute small bowel obstruction due to gallstone ileus.
An 82-year-old man, with previously diagnosed cholelithiasis, presented with abdominal pain and vomiting for nine days. The contracted gallbladder with distended bowel loops was visualized on abdominal ultrasound. Computed tomography of the abdomen and pelvis revealed dilated loops of the small intestine with a gallstone in the proximal ileum, causing intestinal obstruction with pneumobilia, suggesting gallstone ileus with cholecystoduodenal fistula. The patient underwent an emergency laparotomy and enterolithotomy to remove the impacting gallstone. The cholecystoduodenal fistula was left undisturbed due to the significant risk of duodenal injury. The patient had an uneventful postoperative recovery.
Gallstone ileus almost always requires surgical management. However, performing an interval biliary surgery is based on the clinical judgment of the surgeon. In our case, the patient's clinical status determined the treatment in which an enterotomy with stone extraction alone was largely sufficient, and has supported the literature. Gallstone ileus is an important differential diagnosis in elderly patients with gallstone disease, untreated or undiagnosed, presenting with features of small bowel obstruction.
胆石性肠梗阻是由胃肠道内一个或多个胆结石嵌顿引起的，导致机械性肠梗阻。它是胆石症的一种罕见并发症，可导致胆囊肠瘘形成，且死亡率较高。我们报告一例因胆石性肠梗阻导致的非典型亚急性小肠梗阻病例。
一名82岁男性，既往诊断为胆石症，出现腹痛和呕吐9天。腹部超声显示胆囊缩小，肠袢扩张。腹部和盆腔计算机断层扫描显示小肠肠袢扩张，在回肠近端有一颗胆结石，导致肠梗阻并伴有气腹，提示胆石性肠梗阻合并胆囊十二指肠瘘。患者接受了急诊剖腹手术和肠石切除术以取出嵌顿的胆结石。由于十二指肠损伤风险较大，未处理胆囊十二指肠瘘。患者术后恢复顺利。
胆石性肠梗阻几乎总是需要手术治疗。然而，择期胆道手术需根据外科医生的临床判断来决定。在我们的病例中，患者的临床状况决定了治疗方案，即仅行肠切开取石术在很大程度上就足够了，这也得到了文献的支持。胆石性肠梗阻是老年胆石症患者出现小肠梗阻特征时的重要鉴别诊断，这些患者可能未接受治疗或未被诊断。
