Luckman Matthew, Ha Rebecca, Vu Alexander H, Han Jane, Golden Adam, Victory Jesse
Surgery, Georgetown University School of Medicine, Washington, USA.
Neurobiology, University of California San Diego, San Diego, USA.
Cureus. 2024 Dec 1;16(12):e74912. doi: 10.7759/cureus.74912. eCollection 2024 Dec.
Gallstone ileus, a rare cause of mechanical bowel obstruction, occurs due to the formation of a cholecystenteric fistula allowing gallstones to migrate into the gastrointestinal tract. The condition occurs mostly in elderly patients, particularly women, and carries a significant mortality risk due to delayed diagnosis. This case report discusses a 77-year-old female patient with a history of chronic medical conditions, who self-presented with periumbilical pain, nausea, and reduced bowel movements. Initial imaging revealed pneumobilia and small bowel obstruction, leading to a diagnosis of partial obstruction attributed to adhesions. Despite surgical intervention and temporary symptom relief, the patient's condition deteriorated due to a subsequent colonic obstruction. The case was complicated by delayed recognition of gallstone ileus, as imaging initially misinterpreted the obstructive mass as a "stool ball" rather than a gallstone. Following diagnostic laparoscopy and subsequent exploratory surgeries, the patient was found to have a gallstone impacted in the rectum, leading to colonic ischemia and perforation. This resulted in progressive renal failure, respiratory failure, and ultimately, the patient's death in hospice care. This case underscores the diagnostic challenges of gallstone ileus and highlights two key delays: misattribution of obstructive symptoms to adhesions and failure to recognize colonic obstruction due to gallstone ileus. Early use of contrast-enhanced imaging and a high index of suspicion are crucial for timely diagnosis. This case emphasizes the importance of thorough inspection of the small bowel and ileocecal region during laparoscopy and the need for careful evaluation of imaging findings to improve patient outcomes in gallstone ileus cases.
胆结石性肠梗阻是机械性肠梗阻的一种罕见病因，是由于形成胆囊肠瘘，使胆结石移入胃肠道所致。这种情况大多发生在老年患者，尤其是女性，由于诊断延误，存在显著的死亡风险。本病例报告讨论了一名77岁有慢性病史的女性患者，她自述有脐周疼痛、恶心和排便减少的症状。初始影像学检查显示气腹和小肠梗阻，诊断为粘连所致的部分梗阻。尽管进行了手术干预且症状暂时缓解，但患者病情因随后的结肠梗阻而恶化。该病例因胆结石性肠梗阻的诊断延迟而复杂化，因为影像学检查最初将梗阻性肿块误判为“粪球”而非胆结石。经过诊断性腹腔镜检查及随后的探查手术，发现患者直肠内有一颗胆结石，导致结肠缺血和穿孔。这进而导致进行性肾衰竭、呼吸衰竭，最终患者在临终关怀中死亡。本病例强调了胆结石性肠梗阻的诊断挑战，并突出了两个关键延误：将梗阻症状归因于粘连以及未能识别由胆结石性肠梗阻导致的结肠梗阻。早期使用增强造影成像和高度的怀疑指数对于及时诊断至关重要。本病例强调了腹腔镜检查期间对小肠和回盲部进行彻底检查的重要性，以及仔细评估影像学检查结果以改善胆结石性肠梗阻病例患者预后的必要性。
