Choi Joseph Do Woong, de Silva Pranesh, Lynch Craig, Pillinger Stephen, Ravindran Praveen
Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Parramatta Road, Sydney, New South Wales 2006, Australia.
Department of Colorectal Surgery, Sydney Adventist Hospital, 185 Fox Valley Road, Wahroonga, Sydney, New South Wales 2076, Australia.
J Surg Case Rep. 2025 Jan 26;2025(1):rjaf026. doi: 10.1093/jscr/rjaf026. eCollection 2025 Jan.
An 84-year-old lady presented with 1 day history of sudden onset generalized abdominal pain, fevers, and peritonism. Computed tomography was suggestive of a mid-small bowel perforation associated with a distal ovoid soft tissue density structure without pneumobilia. An urgent laparotomy demonstrated two areas of jejunal diverticula necrosis and perforation associated with a 3 cm luminal mass in the proximal ileum, and proximal small bowel dilatation. A 100 cm small bowel resection incorporating the mass and perforated jejunal diverticula and primary stapled anastomosis were performed. Histopathology surprisingly demonstrated cholelithiasis consistent with a gallstone ileus and necrotic, perforated jejunal diverticulitis. The patient had no recurrent symptoms at 6 weeks follow-up. The authors report an uncommon and unexpected occurrence of small bowel diverticulitis perforation as a rare complication of gallstone ileus.
一位84岁女性，突发全腹疼痛、发热及腹膜炎1天。计算机断层扫描提示中下段小肠穿孔，伴有远端椭圆形软组织密度结构，未见气腹。急诊剖腹探查发现两处空肠憩室坏死及穿孔，同时在回肠近端有一个3厘米的腔内肿物，近端小肠扩张。行100厘米小肠切除术，切除肿物及穿孔的空肠憩室，并进行一期吻合器吻合。组织病理学检查令人惊讶地发现胆石症，符合胆石性肠梗阻，以及坏死、穿孔的空肠憩室炎。患者在6周随访时无复发症状。作者报道了小肠憩室炎穿孔这种罕见且意外的情况，它是胆石性肠梗阻的一种罕见并发症。
