胆囊缺失的离奇病例：胆囊十二指肠瘘的罕见表现

The Curious Case of a Missing Gallbladder: An Unusual Presentation of a Cholecystoduodenal Fistula.

作者信息

Surapaneni Sarvani, Kiwan Wissam, Chiu Michael K, Zingas Alkis, Hussein Shakir, Ehrinpreis Murray

机构信息

Internal Medicine Department, Wayne State University, Detroit, Michigan, United States.

Gastroenterology Division, University of Southern California, Los Angeles, California, United States.

出版信息

Avicenna J Med. 2021 Dec 2;12(1):34-37. doi: 10.1055/s-0041-1739541. eCollection 2022 Jan.

DOI:10.1055/s-0041-1739541

PMID:35586392

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9110104/

Abstract

Large gallstones could erode through gallbladder wall to nearby structures, causing fistulas, gastric outlet obstruction and gallstone ileus. They typically occur in elderly patients with comorbidities carrying therapeutic challenges. We present a case of a middle-aged woman who was thought to have symptomatic cholelithiasis. Extensive adhesions precluded safe cholecystectomy. While hepatobiliary iminodiacetic acid scan and magnetic resonance imaging with cholangiopancreatography (MRI-MRCP) failed to visualize the gallbladder, computed tomography (CT) was consistent with cholecystoduodenal fistula. A very large gallstone was seen endoscopically in the duodenum, which was broken down into pieces using a large stiff snare.

摘要

大的胆结石可穿透胆囊壁侵蚀至附近结构，导致瘘管形成、胃出口梗阻和胆石性肠梗阻。它们通常发生在患有合并症的老年患者中，带来治疗挑战。我们报告一例中年女性病例，该患者被认为患有症状性胆石症。广泛的粘连使安全的胆囊切除术无法进行。虽然肝胆亚氨基二乙酸扫描和磁共振胰胆管造影（MRI-MRCP）未能显示胆囊，但计算机断层扫描（CT）结果符合胆囊十二指肠瘘。在内镜下可见十二指肠内有一颗非常大的胆结石，使用大的硬圈套器将其破碎成小块。