Pichardo Jesús, Zapata Joel, Echavarría Radhanilda, Ubiñas Raúl, Báez Pedro, Gómez Ángel
Department of Surgery and Specialties, CEDIMAT (Centros de Diagnóstico y Medicina Avanzada y de Conferencias Médicas y Telemedicina), Santo Domingo, DOM.
Department of Gastroenterology, CEDIMAT (Centros de Diagnóstico y Medicina Avanzada y de Conferencias Médicas y Telemedicina), Santo Domingo, DOM.
Cureus. 2023 Apr 3;15(4):e37077. doi: 10.7759/cureus.37077. eCollection 2023 Apr.
Mechanical small-bowel obstruction can occur due to various reasons, including the impaction of a gallstone in the ileum after it has passed through a cholecystoenteric fistula. Gallstone ileus is an infrequent yet significant cause of this condition. This case report documents an instance of gallstone ileus, which accounts for less than 1% of patients with mechanical small bowel obstruction. We report a 75-year-old female patient who presented with colicky pain in both upper quadrants, hyporexia, and constipation that worsened during a period of nine days, which subsequently was accompanied by nausea and vomiting of bilious appearance in the next three days. Abdominal CT reported a dilated common bile duct (1.7 cm) with multiple stones inside measuring between 5 and 8 mm associated with pneumobilia of intrahepatic bile ducts and dilatation of small intestinal loops produced by a high-density image of approximately 2.5 cm. Laparoscopic exploration showed an obstructive mass measuring 15 cm from the ileocecal valve corresponding to a 2.54 x 2.35 cm gallstone, which was removed and enterorrhaphy was performed. The sine qua non condition for gallstone ileus to occur is the presence of a fistula between the gallbladder and the gastrointestinal tract. The treatment is mainly surgical and should be aimed primarily at the intestinal obstruction and secondarily at the cholecystoenteric fistula. This condition tends to have a high rate of complications and consequently long hospital stays. Making a timely diagnosis provides us with the tools for a surgical approach aimed at intestinal obstruction and subsequently in the management of the biliary fistula.
机械性小肠梗阻可由多种原因引起，包括胆结石经胆囊肠瘘进入回肠后造成的嵌顿。胆石性肠梗阻是导致这种情况的一个少见但重要的原因。本病例报告记录了一例胆石性肠梗阻病例，其在机械性小肠梗阻患者中所占比例不到1%。我们报告了一名75岁女性患者，她出现上腹部绞痛、食欲减退和便秘，在九天内病情加重，随后在接下来的三天里伴有恶心和胆汁样呕吐。腹部CT报告显示胆总管扩张（1.7厘米），内有多个直径在5至8毫米之间的结石，伴有肝内胆管积气以及由一个约2.5厘米的高密度影像导致的小肠袢扩张。腹腔镜探查显示距回盲瓣15厘米处有一个阻塞性肿块，对应一颗2.54×2.35厘米的胆结石，将其取出并进行了肠修补术。胆石性肠梗阻发生的必要条件是胆囊与胃肠道之间存在瘘管。治疗主要是手术治疗，应首先针对肠梗阻，其次针对胆囊肠瘘。这种情况往往并发症发生率高，因此住院时间长。及时诊断为我们提供了针对肠梗阻进行手术以及后续处理胆瘘的方法。
