老年胆石性肠梗阻2例

<正>患者1男,77岁。主诉突发脐周疼痛2天,起初为隐痛,逐渐加重,伴恶心呕吐数次,为胃内容物,无肛门排便排气一天,无畏寒发热及黄疸。患者既往无类似腹痛发作史,亦无外伤及手术史。查体:腹部平坦,中下腹轻压痛,无肌紧张及反跳痛,未扪及明显肿块,murphy征(-),肠鸣音4～5次/min。全腹部CT扫描示肝内胆管积气,胆囊萎陷并见积气,左中腹肠管内见一圆形层状高密度影,直径约4cm,周围肠壁增厚,MPR重建清晰显示结石位置(图1,2)。后患者     

胆囊十二指肠瘘伴胆石性肠梗阻1例

1病例介绍 患者女性,65岁,间歇性右上腹痛12年,曾多次作B超检查诊为胆囊结石。入院前两天上腹疼痛发作伴恶心、呕吐、腹胀,发病初期肛门尚能排气、排便,后渐停止排气排便。在当地医院给予解痉止痛、抗炎等措施治疗无好转转入我院。     

胆石性肠梗阻1例

<正>患者女,74岁。因"10天前无诱因右上腹胀痛伴停止排气、排便"就诊,病程中常伴恶心、呕吐,呕吐物为胃内容物。查体:腹部膨隆,右上腹压痛,Murphy征(+),腹部叩诊呈鼓音,肠鸣音活跃,可闻及气过水声,无血管杂音。血常规:白细胞15.14×10⁹/L,中性粒细胞百分比80.50%,中性粒细胞计数12.17×10⁹/L。既往胆囊结石3年。     

胆石性肠梗阻1例

病例介绍：患者女性，64岁，因活动后心悸、气促3年，加重伴胸闷、恶心、呕吐人心内科。入院前2天呕吐，4次／日。入院后呕吐3。4次／日，为胃内容物，感上腹饱胀。入院前一直服用地高辛0．25mg／次，1次／日。心电图示心房纤颤。既往无手术病史，有慢性支气管炎，肺气肿病史。院外B超检查提示胆总管结石。我院CT检查诊断胆囊及胆总管下段多发性结石，约3．0×1．5cm大小负性影。体温：36．6℃；[第一段]     

胆石性肠梗阻二例

胆石性肠梗阻是胆系结石进入肠道所致的机械性肠梗阻。本病少见，占全部肠梗阻的1％～4％，术前临床诊断较为困难，术前诊断符合率仅为31％～48％。笔者遇到2例，报道如下。     

影像诊断胆石性肠梗阻1例

1 病历简介 1.1 临床资料患者,女,66岁.因间断性下腹疼痛伴停止排气排便10天入院.10天前无明显诱因,出现间断性下腹部疼痛伴腹胀及停止排气排便.病程中频发恶心,呕吐,呕吐物均为胃内容物.于2008年8月17日收入我院.入院诊断: (1) 肠梗阻;(2) 胆囊结石;(3) 糖尿病.给予通便灌肠,抗炎,对症支持治疗后,病情好转.2008年8月20日出院.出院后,进食后又出现恶心,呕吐,并停止排便,排气,再次收入我院诊治.既往史: 糖尿病病史3年.     

胆石性肠梗阻诊治体会

肠梗阻是外科常见急腹症之一 ,它的特点是肠内容物不能通过肠道而引起的病理生理变化及临床表现。胆石性肠梗阻是由于一个或多个胆石嵌顿肠腔引起机械性阻塞。本文收集本院 1987- 0 1～ 2 0 0 1- 12收治 6例胆石性肠梗阻资料 ,报道如下。1　临床资料1.1　一般资料 :本组男性 2例 ,女性 4例。年龄 5 6～ 81岁 ,平均 68.5岁。均以急腹症入院 ,发病时间最短 3ｄ ,最长 1周。入院时有典型机械肠梗阻表现。腹部平片均提示 :小肠积气、扩张、肠腔内液平面。有 1例腹部平片提示胆道内积气。Ｂ超提示胆囊图形异常 2例 ,胆囊萎缩 1例 ,胆囊图形显示不…     

胆石性肠梗阻的影像诊断

目的研究胆石性肠梗阻影像表现及其诊断价值.方法回顾性分析15例经临床证实的胆石性肠梗阻患者的影像表现及其诊断价值.结果所有病例CT表现均见肠梗阻征象、肠腔内迷走结石（异位结石）及胆囊、胆系积气,2例显示腹腔游离积液,除1例胆囊切除者外另14例均见胆囊变形,胆囊与十二指肠分界不清,4例可见明确显示胆肠瘘.5例同时进行了腹部立卧位X线平片检查,其中1例碘水造影显示机械性肠梗阻、肠腔内充盈缺损、胆肠瘘,1例显示胆管积气,3例显示肠梗阻征象,2例未见异常.7例同时进行了腹部超声检查,均提示胆囊异常,其中3例显示胆系积气.结论胆石性肠梗阻有典型的CT表现,CT是胆石性肠梗阻最佳诊断方法,X线平片及超声可以作为筛查手段.     

A cholecysto-enteric fistula with a gallstone ileus diagnosed by CT]

Gallstone ileus is an uncommon but severe complication of cholecystitis, which can only occur following perforation of the gallbladder and formation of a cholecystoenteric fistula. The diagnosis can be established by means of abdominal plain film when the classic triad described by Rigler (small-bowel obstruction, ectopic gallstone and pneumobilia) is observed. A patient with abdominal obstruction and equivocal findings on plain film X-ray and abdominal sonography is presented, in whom the gallstone ileus was reliably diagnosed by CT.     

Atypical cases of gallstone ileus evaluated with multidetector computed tomography

OBJECTIVE: To describe the multidetector computed tomography (CT) findings in 3 patients with atypical gallstone ileus. METHODS: We retrospectively evaluated computed radiography and CT images from three cases of surgically proven gallstone ileus. Two radiologists evaluated by consensus all images for the presence of ectopic gallstone, small bowel obstruction, intrahepatic pneumobilia, cholecystic pneumobilia. One author recorded whether diagnosis of gallstone ileus was made prospectively on radiologic reports and correlated findings to pathology. RESULTS: All cases of gallstone ileus were atypical in that one patient had porcelain gallbladder, one had recurrent pyogenic cholangitis, and one was only 35 years of age. Prospective clinical diagnosis of gallstone ileus was made in only 1 patient at computed radiography and all 3 patients at CT. Retrospectively, small bowel obstruction and cholecystic pneumobilia were identified retrospectively in all 3 patients at both computed radiography and MDCT, and an ectopic gallstone, intrahepatic pneumobilia, and choledochoduodenal fistula was seen in 2, 1, and 0 patients at computed radiography and 3, 2, and 3 patients at CT respectively. CONCLUSION: Multidetector CT is an accurate means to diagnose gallstone ileus, even in patients with atypical features. In particular, multidetector CT is useful for identifying the ectopic gallstone at the transition point between dilated and decompressed bowel.     

胆囊十二指肠内瘘伴胆石性肠梗阻的CT诊断价值分析

目的:评价螺旋CT对胆囊-十二指肠内瘘伴胆石性肠梗阻的诊断价值。方法:对8例经手术证实为胆囊-十二指肠内瘘伴胆石性肠梗阻的螺旋CT表现及重建技术进行回顾性分析。结果:8例患者中,2例胆石位于十二指肠降段;2例位于空肠;1例位于空回肠交界处;另外3例位于回肠内。胆石短径为(4.70±1.20)cm,长径为(6.09±1.90)cm。胆囊-十二指肠内瘘伴胆石性肠梗阻的CT直接征象主要有瘘口的显示以及胆石位于梗阻段肠腔内;间接征象主要有胆囊及胆道积气;胆囊塌陷及胆囊与十二指肠分界模糊、结构紊乱;肠梗阻。以上两种直接征象若同时存在即可作出诊断,如一种直接征象同时伴有两种或两种以上间接征象亦可作出诊断。结论:胆囊-十二指肠内瘘伴胆石性肠梗阻具有典型的CT表现,螺旋CT能够对其作出明确诊断。     

Resolution of gallstone ileus with spontaneous evacuation of gallstone

Gallstone ileus (GSI) is a rare cause of small bowel obstruction (SBO). Even more extraordinary is the spontaneous evacuation of a gallstone, which has caused SBO. A 69-year-old gentleman presented with symptoms and signs of SBO. His plain abdominal X-ray revealed dilated loops of the small bowel and opacity in the region of the terminal ileum consistent with a diagnosis of GSI. Because of severe cardiorespiratory co-morbidities, the patient was treated conservatively and improved within 24 h. A CT scan revealed that the stone had passed into the rectum and was spontaneously evacuated. If the gallstone is <2.5 cm on CT scan, spontaneous evacuation is a real possibility and initial conservative treatment in a high-risk surgical patient is a consideration.     

Recurrent gallstone ileus: a case report

Gallstone ileus is a rare complication of recurrent gallstone cholecystitis and usually occurs in elderly female patients. Recurrent gallstone ileus occurs in 5% of patients with a previous episode of gallstone ileus and is associated with a mortality of 20%. We present a 52-year-old female with recurrent gallstone ileus 1 year after her initial episode. Electronic Publication