Vallejo Kevin, Morales Claudia, Denton Alexa, Vakil Deep, Castro Hernandez Lucia, Vallejo Charles, Moghul Fazaldin, Seaver Christopher
College of Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Department of Surgery, Memorial Healthcare System, Hollywood, USA.
Cureus. 2024 Nov 20;16(11):e74123. doi: 10.7759/cureus.74123. eCollection 2024 Nov.
Gallstone ileus is the mechanical obstruction of the bowel due to gallstone impaction. It forms when a fistula is created between the gallbladder and the gastrointestinal tract, which can result in small bowel obstruction. Its surgical management ranges from enterolithotomy, cholecystectomy, and fistula closure performed together (one-stage) or performed separately (two-stage), while some patients undergo simple enterolithotomy. Emergency surgery with open enterolithotomy, with or without biliary tract surgery, has been replaced by laparoscopic-assisted enterolithotomy as a safer and more rapid procedure. This report is of a 68-year-old woman treated with laparoscopic-assisted enterolithotomy for gallstone ileus which recurred. A 68-year-old woman with type 2 diabetes mellitus, hypertension, breast cancer, and end-stage renal disease on hemodialysis presented with a gallstone ileus and was surgically managed with successful laparoscopic-assisted enterolithotomy. Seven days after the initial surgery, she again presented with gallstone ileus requiring reoperation. A repeat laparoscopic-assisted enterolithotomy was performed with no complications and full resolution of her symptoms. Operative management of gallstone ileus and subsequent recurrence continues to be highly debated. With no randomized studies and limited data, there is no current gold standard surgical procedure for either setting. Simple laparoscopic-assisted enterolithotomy is the favored surgical technique as it is associated with decreased morbidity, mortality, operative time, and complications. This report demonstrates that a CT scan is crucial in differentiating recurrent gallstone ileus from postoperative ileus, with a repeat laparoscopic-assisted enterolithotomy providing a safe and effective treatment option. Moreover, patient follow up is essential for monitoring symptom resolution.
胆石性肠梗阻是由于胆结石嵌顿导致的肠道机械性梗阻。当胆囊与胃肠道之间形成瘘管时，就会引发胆石性肠梗阻，进而导致小肠梗阻。其手术治疗方式包括同时进行（一期）或分别进行（二期）的取石术、胆囊切除术和瘘管闭合术，而一些患者仅接受单纯的取石术。开放式取石术（无论是否同时进行胆道手术）这种急诊手术，已被腹腔镜辅助取石术所取代，后者是一种更安全、更快速的手术方法。本报告介绍了一名68岁女性，因复发性胆石性肠梗阻接受腹腔镜辅助取石术治疗的病例。一名患有2型糖尿病、高血压、乳腺癌且处于血液透析阶段的终末期肾病的68岁女性，因胆石性肠梗阻就诊，并通过腹腔镜辅助取石术成功进行了手术治疗。初次手术后七天，她再次出现胆石性肠梗阻，需要再次手术。再次进行了腹腔镜辅助取石术，未出现并发症，症状完全缓解。胆石性肠梗阻及其后续复发的手术治疗仍存在高度争议。由于缺乏随机研究且数据有限，目前无论是哪种情况都没有金标准的手术方法。单纯的腹腔镜辅助取石术是首选的手术技术，因为它与发病率、死亡率、手术时间和并发症的减少相关。本报告表明，CT扫描对于鉴别复发性胆石性肠梗阻与术后肠梗阻至关重要，再次进行腹腔镜辅助取石术提供了一种安全有效的治疗选择。此外，对患者进行随访对于监测症状缓解情况至关重要。
