Matli Venkata Vinod Kumar, Marler Kevin C, Morgan Andre, Pujala Varsha, Pandit Sudha, Morris James
Internal Medicine, Christus Highland Medical Center, Shreveport, USA.
General Surgery, Christus Highland Medical Center, Shreveport, USA.
Cureus. 2023 Sep 5;15(9):e44707. doi: 10.7759/cureus.44707. eCollection 2023 Sep.
Gallstones causing bowel obstruction, known as gallstone ileus, are rare and account for less than 0.5% of small bowel obstruction cases. Additionally, it is a rare complication affecting only 0.3% of patients who have gallstones. Fistula formation between the biliary system, most commonly between the gallbladder and duodenum because of their proximity, facilitates the migration of gallstones into the enteric system with subsequent impaction in the small intestine, usually in the distal ileum close to the ileocecal valve, promoting the development of mechanical small bowel obstruction. Computerized tomography of the abdomen and pelvis is a confirmatory and widely used imaging study when there are two signs of Rigler's triad, which includes pneumobilia, evidence of small bowel obstruction and the presence of radiopaque stones. We report a case of a 75-year-old Caucasian man who presented with abdominal distention with signs of severe dehydration secondary to intractable nausea and vomiting complicated with severe acute kidney injury and was found to have a 4.7-centimeter gallstone-induced small intestinal obstruction.
导致肠梗阻的胆结石，即胆石性肠梗阻，较为罕见，占小肠梗阻病例的比例不到0.5%。此外，它是一种罕见的并发症，仅影响0.3%的胆结石患者。胆道系统之间形成瘘管，最常见的是胆囊和十二指肠之间，由于它们距离较近，有利于胆结石迁移到肠道系统，随后在小肠中嵌顿，通常在靠近回盲瓣的回肠末端，从而引发机械性小肠梗阻。当出现里格勒三联征的两个征象时，腹部和盆腔计算机断层扫描是一种常用的确诊性影像学检查，里格勒三联征包括气腹、小肠梗阻证据和不透射线结石的存在。我们报告一例75岁的白人男性病例，该患者因顽固性恶心和呕吐继发严重脱水，并伴有严重急性肾损伤，出现腹胀，经检查发现有一枚4.7厘米的胆结石导致小肠梗阻。
