Alouani Hazem, Trabelsi Mohamed Mahdi, Nasri Salsabil, Safta Amine Ben, Jerraya Hichem, Nouira Ramzi
Department of General Surgery B, Charles Nicole's Hospital, Tunis, Tunisia.
Department of General Surgery B, Charles Nicole's Hospital, Tunis, Tunisia.
Int J Surg Case Rep. 2025 Oct;135:111924. doi: 10.1016/j.ijscr.2025.111924. Epub 2025 Sep 8.
Gallstone ileus is a rare and potentially life-threatening complication of chronic cholecystitis in the elderly. It results from the passage of a large gallstone through a bilio-digestive fistula into the gastrointestinal tract, causing mechanical obstruction. Early diagnosis and surgical intervention are crucial to reducing associated morbidity and mortality.
We report two cases of gallstone ileus. Case 1: A 76-year-old man presented with vomiting, abdominal pain, and bowel obstruction. CT scan revealed pneumobilia and an obstructing gallstone in the distal ileum. A 3 cm stone was extracted via enterotomy, and a loop ileostomy was performed due to poor bowel viability. Case 2: A 65-year-old hypertensive woman presented with acute intestinal obstruction and hypovolemic shock. CT imaging showed a gallstone in the distal ileum. Enterolithotomy was performed initially, and a second surgery three months later included cholecystectomy and fistula repair.
Gallstone ileus accounts for 1-4 % of intestinal obstructions, more common in the elderly. Rigler's triad is diagnostic but only seen in one-third of patients. CT imaging is the gold standard. Treatment typically involves enterolithotomy, with cholecystectomy and fistula repair deferred in high-risk patients.
Gallstone ileus should be suspected in elderly patients with signs of obstruction and pneumobilia. CT imaging is essential for diagnosis. Individualized surgical strategies optimize outcomes.
胆石性肠梗阻是老年人慢性胆囊炎罕见且可能危及生命的并发症。它是由一颗大的胆结石通过胆肠瘘进入胃肠道，导致机械性梗阻所致。早期诊断和手术干预对于降低相关发病率和死亡率至关重要。
我们报告两例胆石性肠梗阻病例。病例1：一名76岁男性，表现为呕吐、腹痛和肠梗阻。CT扫描显示气腹和回肠末端有梗阻性胆结石。通过肠切开术取出一颗3厘米的结石，由于肠活力差，进行了回肠袢造口术。病例2：一名65岁的高血压女性，表现为急性肠梗阻和低血容量性休克。CT成像显示回肠末端有一颗胆结石。最初进行了肠石切除术，三个月后的第二次手术包括胆囊切除术和瘘管修复。
胆石性肠梗阻占肠梗阻的1% - 4%，在老年人中更常见。里格勒三联征具有诊断意义，但仅见于三分之一的患者。CT成像是金标准。治疗通常包括肠石切除术，高危患者可推迟进行胆囊切除术和瘘管修复。
对于有梗阻体征和气腹的老年患者，应怀疑胆石性肠梗阻。CT成像对诊断至关重要。个体化的手术策略可优化治疗效果。
