背景:胆结石性肠梗阻是一种罕见的胆石症,与胆囊和肠道之间瘘管的形成有关。它负责少于0.1%的机械性肠梗阻病例。
方法:一名54岁的男性高血压患者出现肠梗阻症状,包括无法通过大便,厌食症,腹痛,呕吐,和少尿。体格检查显示上腹部压痛和腹部扩张,无黄疸。实验室检查提示轻度贫血。患者最初拒绝任何手术干预,所以他接受了24小时的保守治疗。随后,进行了紧急探查性开腹手术,发现胆结石导致小肠梗阻.收缩的回肠环,长度为15厘米,石头撞击被切除,并进行了端对端吻合。发现并修复了胆囊胃瘘,进行了逆行胆囊切除术.患者康复,无并发症。
结论:胆石性肠梗阻发生在胆囊和肠道之间形成瘘管。值得注意的是,连接胆囊和胃的瘘管的存在范围从0%到13.3%。胆囊肠瘘(CEF)通常发生在年龄第七或第八十年的老年妇女中。诊断通常依赖于CT扫描,手术干预仍然是主要的治疗方法。有趣的是,尽管提高了意识和成像技术,一些病例仍然是在手术中偶然发现的。
结论:这个案例突出了胆石性肠梗阻带来的诊断和治疗挑战,并强调在急性腹部梗阻的鉴别诊断中考虑胆结石相关疾病的重要性。
BACKGROUND: Gallstone ileus is a rare condition resulting from cholelithiasis, associated with the formation of a fistula between the gallbladder and the intestinal tract. It is responsible for less than 0.1 % of cases of mechanical bowel obstruction.
METHODS: A 54-year-old male with hypertension presented with symptoms of intestinal obstruction, including inability to pass stool, anorexia, abdominal pain, vomiting, and oliguria. Physical examination revealed epigastric tenderness and a distended abdomen without jaundice. Laboratory tests indicated mild anemia. The patient initially refused any surgical interventions, so he was placed on conservative treatment for 24 h. Subsequently, an emergency exploratory open laparotomy was performed, revealing a gallstone causing small bowel obstruction. A constricted ileal loop, 15 cm in length, with stone impaction was resected, and an end-to-end anastomosis was performed. A cholecystogastric fistula was identified and repaired, and a retrograde cholecystectomy was performed. The patient recovered without complications.
CONCLUSIONS: Gallstone ileus occurs when a fistula develops between the gallbladder and the intestinal tract. Notably, the presence of a fistula connecting the gallbladder and stomach ranges from 0 % to 13.3 %. Cholecystoenteric fistulas (CEFs) typically occur in elderly women in their seventh or eighth decade of life. Diagnosis often relies on CT scanning, and surgical intervention remains the primary treatment. Interestingly, despite improved awareness and imaging techniques, some cases are still discovered incidentally during surgery.
CONCLUSIONS: This case highlights the diagnostic and therapeutic challenges posed by gallstone ileus, and emphasizes the importance of considering gallstone-related disorders in differential diagnoses for acute abdominal obstruction.