Schumacher G, Keck H, Neuhaus P
Chirurgische Klinik und Poliklinik, Virchow Klinikum, Humboldt Universität zu Berlin.
Zentralbl Chir. 1996;121(5):408-11.
Gallstone ileus is a rare complication of cholecystolithiasis with a high mortality because of the advanced age of the patients and the often delayed diagnosis. Signs of a cholecystoduodenal fistula are often absent in conventional ultrasonic and radiological methods. Treatment options are: 1. Enterolithotomy, 2. One stage procedure or 3. Two stage procedure consisting of enterolithotomy and the surgery of the biliary tract. In the case of our patient we performed a conventional cholecystectomy and the closure of the cholecystoduodenal fistula, which was found accidentally. When the gallstone ileus appeared 6 days later the enterolithotomy was performed. Thus in case of accidentally found cholecystoduodenal fistula an exploration of the abdominal cavity and the small intestine to find the gallstone should be performed on principle. Gallstones with a diameter of more than 2-3 cm should be removed by enterolithotomy to prevent the gallstone ileus.
胆石性肠梗阻是胆囊结石的一种罕见并发症，由于患者年龄较大且诊断往往延迟，其死亡率较高。传统超声和放射学检查方法通常无法发现胆囊十二指肠瘘的迹象。治疗方案有：1. 肠石切除术；2. 一期手术；或3. 由肠石切除术和胆道手术组成的二期手术。对于我们的患者，我们进行了常规胆囊切除术并意外发现了胆囊十二指肠瘘并予以闭合。6天后出现胆石性肠梗阻时，进行了肠石切除术。因此，原则上，如果意外发现胆囊十二指肠瘘，应探查腹腔和小肠以寻找结石。直径超过2 - 3厘米的结石应通过肠石切除术取出，以预防胆石性肠梗阻。
