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1.
Chou JW Hsu CH Liao KF Lai HC Cheng KS Peng CY Yang MD Chen YF 《World journal of gastroenterology : WJG》2007,13(8):1295-1298
Gallstone ileus is a rare disease and accounts for 1%-4% of all cases of mechanical intestinal obstruction. It usually occurs in the elderly with a female predominance and may result in a high mortality rate. Its diagnosis is difficult and early diagnosis could reduce the mortality. Surgery remains the mainstay of treatment. We report two cases of gallstone ileus. The first was a 78-year old woman who had a 2-d history of vomiting and epigastralgia. Plain abdominal film suggested small bowel obstruction clinically attributed to adhesions. Later on, gallstone ileus was diagnosed by abdominal computed tomography (CT) based on the presence of pneumobilia, bowel obstruction, and an ectopic stone within the jejunum. She underwent emergent laparotomy with a one-stage procedure of enterolithotomy, cholecystectomy and fistula repair. The second case was a 76-year old man with a 1-wk history of epigastralgia. Plain abdominal film showed two round calcified stones in the right upper quadrant. Fistulography confirmed the presence of a cholecystoduodenal fistula and gallstone ileus was also diagnosed by abdominal CT. We attempted to remove the stones endoscopically, but failed leading to an emergent laparotomy and the same one-stage procedure as for the first case. The postoperative courses of the two cases were uneventful. Inspired by these 2 cases we reviewed the literature on the cause, diagnosis and treatment of gallstone ileus. 相似文献
2.
We describe a patient who presented with mechanical obstruction of the small bowel secondary to impaction of the ileocecal valve from a gallstone. The stone impaction of the ileocecal valve was confirmed by colonoscopy. Although the stone was disimpacted, it could not be trapped and extracted during colonoscopy. Thereafter, the patient's small bowel obstruction was relieved with no further intervention. Even though surgery is the gold standard for the management of gallstone ileus. colonoscopy can be useful in management of patients with gallstone ileus in whom surgery is contraindicated. A review of the literature is also presented. 相似文献
3.
Akiko Taira Masami Yamada Yasunori Takehira Fujito Kageyama Shigeto Yoshii Gou Murohisa Kenichi Yoshida Yasushi Iwaoka Tomohiro Terai Takahiro Uotani Shinya Watanabe Hidenao Noritake Yoshito Ikematu Toshikazu Kanai 《Nihon Shokakibyo Gakkai zasshi》2008,105(4):578-582
Gallstone ileus is a rare but important cause of small bowel obstruction in the geriatric population. A 65-year-old man with a twenty year history of cholecystolithiasis was admitted to our hospital with abdominal pain and vomiting. Physical exams showed abdominal defence and rebound tenderness. A plain abdominal X-ray suggested a small bowel obstruction and pneumobilia. CT scan revealed a 2.5-cm gallstone at the jejunum and air in the biliary tree. The patient underwent a emergency laparotomy based on a diagnosis of panperitonitis with a perforation associated with gallstone ileus. Operative findings revealed a jejunal perforation and a impacted stone on the anal side of perforation. Enterolithotomy and jejunal resection were performed with cholecystectomy and repairment of the cholecystoduodenal fistula. 相似文献
4.
Value of CT in the diagnosis and management of gallstone ileus 总被引:15,自引:1,他引:15
Yu CY Lin CC Shyu RY Hsieh CB Wu HS Tyan YS Hwang JI Liou CH Chang WC Chen CY 《World journal of gastroenterology : WJG》2005,11(14):2142-2147
AIM: To retrospectively establish the diagnostic criteria of gallstone ileus on CT, and to prospectively apply these criteria to determine the diagnostic accuracy of CT to confirm or exclude gallstone ileus in patients who presented with acute small bowel obstruction (SBO). Another purpose was to ascertain whether the size of ectopic gallstones would affect treatment strategy. METHODS: Fourteen CT scans in cases of proved gallstone ileus were evaluated retrospectively by two radiologists for the presence or absence of previously reported CT findings to establish the diagnostic criteria. These criteria were applied in a prospective contrast enhanced CT study of 165 patients with acute SBO, which included those 14 cases of gallstone ileus. The hard copy images of 165 CT studies were reviewed by a different group of two radiologists but without previous knowledge of the patient's final diagnosis. All CT data were further analyzed to determine the diagnostic accuracy of gallstone ileus when using CT in prospective evaluation of acute SBO. The size of ectopic gallstone on CT was correlated with the clinical course. RESULTS: The diagnostic criteria of gallstone ileus on CT were established retrospectively, which included: (1) SBO; (2) ectopic gallstone; either rim-calcified or total-calcified; (3) abnormal gall bladder with complete air collection, presence of air-fluid level, or fluid accumulation with irregular wall. Prospectively, CT confirmed the diagnosis in 13 cases of gallstone ileus with these three criteria. Only one false negative case could be identified. The remaining 151 patients are true negative cases and no false positive case could be disclosed. The overall sensitivity, specificity and accuracy of CT in diagnosing gallstone ileus were 93%, 100%; and 99%, respectively. Surgical exploration was performed in 13 patients of gallstone ileus with ectopic stones sized larger than 3 cm. One patient recovered uneventfully following conservative treatment with an ectopic stone sized 2 cm in the long axis. CONCLUSION: Contrast enhanced CT imaging offered crucial evidence not only for the diagnosis of gallstone ileus but also for decision making in management strategy. 相似文献
5.
Hee K. Yang M.D. Paul F. Fondacaro M.D. 《The American journal of gastroenterology》1992,87(12):1846-1848
Small bowel obstruction secondary to an enterolith formed within a duodenal diverticulum is a rare complication. Twenty-nine cases of enterolith ileus have been reported in the literature. This is a case report of the 30th, with review of the literature. Enterolith ileus closely resembles gallstone ileus in its clinical presentation. Diagnosis is established by documenting normalcy of gallbladder and the presence of small bowel diverticula. 相似文献
6.
Yoshida H Tajiri T Mamada Y Taniai N Hirakata A Kawano Y Mizuguchi Y Arima Y Uchida E Uchida E 《Hepato-gastroenterology》2004,51(55):33-35
An unusual case of choledocholithiasis followed by gallstone ileus documented by serial computed tomography is reported. A 91-year-old woman underwent gastrostomy because she repeatedly developed aspiration pneumonia, and a common bile duct stone was detected. She and her family refused surgery once symptoms resolved. One year later, she presented with increasing, intermittent abdominal pain and nausea. Abdominal computed tomography revealed a common bile duct stone with inflammatory changes, but the patient still refused surgery. Three months later, she was admitted with abdominal pain and vomiting. On admission, plain abdominal radiographs demonstrated proximal small bowel obstruction. A long ileus tube was inserted through the gastric fistula. Two days after admission, gallstone ileus was diagnosed on abdominal computed tomography based on the presence of pneumobilia, disappearance of the common bile duct stone, fluid-filled bowel loops, and the discovery of an impacted stone in the small bowel. Ten and 15 days after admission, repeated computed tomography demonstrated the impacted stone in the terminal ileum. Seventeen days after admission, a laparotomy was performed, and a 5x3-cm gallstone was removed through an ileotomy. 相似文献
7.
Arioli D Venturini I Masetti M Romagnoli E Scarcelli A Ballesini P Borghi A Barberini A Spina V De Santis M Di Benedetto F Gerunda GE Zeneroli ML 《World journal of gastroenterology : WJG》2008,14(1):125-128
Bouveret's syndrome, defined as gastric outlet obstruction due to a large gallstone, is still one of the most dramatic biliary gallstone complications. Although new radiological and endoscopic techniques have made pre-surgical diagnosis possible in most cases and the death rate has dropped dramatically, "one-stage surgery" (biliary surgery carried out at the same time as the removal of the gut obstruction) should be still considered as the gold standard for the treatment of gallstone ileus. In this case, partial gastric outlet obstruction resulted in an atypical and insidious clinical presentation that allowed us to perform the conventional one-stage laparatomic procedure that completely solved the problem, thus avoiding any further complications. 相似文献
8.
RICHARD A. COOPER M.D. PETER KUCHARSKI M.D. 《The American journal of gastroenterology》1978,70(2):175-178
Callstone ileus is, of course, a well known cause of small bowel obstruction. A gallstone, however, is a very rare cause of gastric outlet obstruction. Three cases illustrating this phenomenon are exhibited. Radiographs were diagnostic in two of the studies. All three patients did well postoperatively. 相似文献
9.
S. -M. Bouchentouf I. Sall H. El Kaoui H. Baba A. Aitali A. Zentar K. Sair 《Journal Africain d'Hépato-Gastroentérologie》2009,3(1):32-34
The authors report the particular case of an intestinal obstruction caused by gallstone ileus, associated with Meckel’s diverticulum. One stage surgery, involving suture of a cholecysto-duodenal fistula and jejunal resection of the diverticulum with extraction of the gallstone, was performed. Post-operative follow-up was uneventful. The authors discuss management strategies for gallstone ileus and its particular association with Meckel diverticulum. 相似文献
10.
Siong-Seng Liau Andrew Bamber Malcolm MacFarlane Justin Alberts 《Clinical journal of gastroenterology》2009,2(3):238-241
Cholecysto-duodenal fistula and gallstone ileus are well-recognised complications of gallstone disease. However, small bowel
necrosis is a rare complication of gallstone disease. We describe a case of gallstone-induced ileal necrosis presenting with
symptoms and signs resembling acute appendicitis. A 79-year-old woman presented to the surgical team with central abdominal
pain which subsequently shifted to the right iliac fossa. Clinically, the patient had localised perotinism in the right iliac
fossa with high inflammatory markers. Abdominal radiography showed no diagnostic features. Initial clinical impression was
that of acute appendicitis. Given that this diagnosis was unlikely in a patient of this age, an abdominal CT scan was performed.
The CT scan showed evidence of a large gallstone causing small bowel obstruction in the presence of a cholecysto-duodenal
fistula. At surgery, she was found to have an area of necrosis with a pin-point perforation at the site of impaction of the
gallstone in the proximal ileum. This occurred secondarily to pressure necrosis from the gallstone impacting at a site where
the small bowel diameter narrows in transition from jejunum to ileum. A limited small bowel resection was performed with an
uncomplicated postoperative course. This case report draws attention to a rare complication of gallstone disease which presents
with a clinical picture similar to acute appendicitis. Preoperative investigation for an elderly patient who presents with
an acute abdomen should include an abdominal CT scan to diagnose any rare disease processes which otherwise may not be suspected. 相似文献
11.
Obstruction at the level of the gastric outlet by a gallstone is defined as Bouveret's syndrome. It is an uncommon form of gallstone ileus. A single gallstone of at least 2.5 cm in diameter is the most common underlying cause of Bouveret's syndrome. Diagnosis is based on the clinical manifestations, existence of pneumobilia, visualization of lithiasis and demonstration of duodenal obstruction. Enterotomy or gastrotomy with or without cholecystectomy and fistula repair is the most common surgical therapy. It has high success rate, with acceptable surgical morbidity and mortality. Heightened awareness of this syndrome may lead to decreased morbidity and mortality. 相似文献
12.
Hayee B Khan HN Al-Mishlab T McPartlin JF 《World journal of gastroenterology : WJG》2003,9(4):883-884
We reported a case of 79-year old woman with known large bowel diverticulosis presenting with small bowel obstruction due to stone impaction - found on plain abdominal X-ray. Contrast studies demonstrated small bowel diverticulosis. At laparotomy, the gall bladder was normal with no stones and no abnormal communication with small bowel - excluding the possibility of a gallstone ileus. Analysis of the stone revealed a composition of bile pigments and calcium oxalate. This was a rare case of small bowel obstruction due to enterolith formation - made distinctive by calcification (previously unreported in the proximal small bowel). 相似文献
13.
Habib E Elhadad A 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2003,5(2):118-122
IntroductionSerious complications can ensue if a gallstone is dropped into the peritoneal cavity during laparoscopic cholecystectomy and not retrieved.Case outlineA 75-year-old-man was admitted with intestinal obstruction 8 years after laparoscopic cholecystectomy. Ultrasound scan and a contrast x-ray of the small bowel showed a gallstone within the small bowel lumen that CT scan had failed to identify. Laparotomy showed a Meckel''s diverticulum plus a 4×6-cm gallstone in the terminal ileum. The gallstone had penetrated into the Meckel''s diverticulum before migrating into the ileum and obstructing it.DiscussionGallstones lost during laparoscopic cholecystectomy can cause an intraperitoneal abscess. In addition, they can migrate through the anterior or posterior abdominal wall or the diaphragm and into the urinary tract or bronchus. The resulting abscess can obstruct the digestive tract or drain into the digestive tract to cause a communicating abscess. It can also drain through the abdominal wall and the digestive tract to cause an enterocutaneous fistula. Lastly, the stone can migrate into the intestine and cause gallstone ileus. Following laparoscopic cholecystectomy, patients with a lost gallstone may suffer from abdominal pain and fever within days or months. Thus, all dropped gallstones should be removed during laparoscopy. 相似文献
14.
Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus 总被引:16,自引:0,他引:16
Gallstone is a common disease with a 10% prevalence in the United States and Western Europe. However, it is only symptomatic in 20-30% of patients, with biliary pain "colic" being the most common symptom. Complications of asymptomatic gallstone disease are generally rare, with an incidence of <1 %/yr. The most common complications of gallstone disease are acute cholecystitis, acute pancreatitis, ascending cholangitis, and gangrenous gallbladder. Less frequent complications include Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Mirizzi syndrome and cholecystocholedochal fistula are two manifestations of the same process that starts with impaction of a gallstone in the gallbladder neck that results in obstruction of the bile duct, causing jaundice. The gallstone may erode into the bile duct, causing cholecystocholedochal fistula. Gallstone ileus refers to small bowel obstruction resulting from the impaction of one or more gallstones after they have migrated through a cholecystoenteric fistula. An accurate diagnosis is essential to the management and prevention of further complications. A variety of imaging and endoscopic modalities are used to make the diagnosis once the condition is suspected clinically. Treatment should be tailored to each individual patient. Management choices include ERCP, lithotripsy (endoscopic or extracorporeal), and surgery. Prognosis is frequently related to early recognition, management of any comorbid conditions, and careful selection of treatment modalities. 相似文献
15.
Gaiani S Serra C Cervellera M Campione O Bolondi L Miglioli M 《The American journal of gastroenterology》2000,95(12):3642-3643
This report describes a patient with a type II Caroli' s disease who developed a gallstone ileus. Previous hepaticojejunostomy operations were thought to have facilitated the migration of stones into the bowel and consequent gallstone ileus. This complication, which was strongly suspected from the clinical history, was diagnosed by ultrasound examination despite the absence of aberrantly located stones on plain abdominal x-ray. Ultrasound is useful in the diagnostic workup of patients with bowel obstruction to confirm obstruction itself, to assess its level, and possibly to identify the cause. 相似文献
16.
A. Ariche D. Czeiger Y. Gortzak G. Shaked I. Shelef I. Levy 《Scandinavian journal of gastroenterology》2013,48(7):781-783
Gallstone has rarely been described as a cause of gastrointestinal obstruction. However, the relative incidence of gallstone ileus increases significantly with age. The gastric outlet is very seldom the location of obstruction by a gallstone. The diagnosis of this condition is not difficult. Nevertheless, if treatment is delayed, high morbidity and mortality rates result. Comprehensive treatment aims to relieve the obstruction, to close the biliodigestive fistula and to prevent further gallbladder complications. The surgeon who deals with this type of illness should tailor the treatment plan according to the age, general condition, and intraoperative findings of the individual patient. This paper presents a case report of an 88-year-old woman with gastric outlet obstruction caused by a gallstone. 相似文献
17.
In a 91-year-old female patient admitted with an ileus, ultrasound and computed tomography demonstrated the obstruction of the upper jejunum by a large gallstone. Due to concurrent diseases the patient was unfit for surgery. An attempt was made to remove the impacted stone endoscopically. After successful mobilization and fragmentation by mechanical lithotripsy the obstruction was cleared away. Since the patient improved considerably after this procedure, the gallbladder and the cholecystoduodenal fistula were left in place. 相似文献
18.
Habib E Khoury R Elhadad A Jarno F Diallo T 《Gastroentérologie clinique et biologique》2002,26(10):930-934
A patient was admitted because of an intestinal obstruction. Eight years before, he underwent a laparoscopic cholecystectomy. Abdominal ultrasonography and small bowel series showed a gallstone in the small bowel that computed tomography scan failed to identify. Laparotomy showed a Meckel's diverticula and a biliary stone in the terminal ileum. In the literature, it has been shown that gallstone lost during laparoscopic cholecystectomy may be responsible for intraperitoneal abscess. In the contact of intestine, the stone may induce an obstructive abscess, a communicating abscess, a digestive fistula or a biliary ileus. During the postoperative course of laparoscopic cholecystectomy, these patients suffer from abdominal pain and fever lasting from few days to several months. Imaging shows the biliary gallstone mechanical complications induced by the stone. To avoid such complications, biliary gallstone that falls into the peritoneum during laparoscopic cholecystectomy should be removed under laparoscopy. 相似文献
19.
Gastric outlet obstruction by gallstone: Bouveret syndrome 总被引:4,自引:0,他引:4
Ariche A Czeiger D Gortzak Y Shaked G Shelef I Levy I 《Scandinavian journal of gastroenterology》2000,35(7):781-783
Gallstone has rarely been described as a cause of gastrointestinal obstruction. However, the relative incidence of gallstone ileus increases significantly with age. The gastric outlet is very seldom the location of obstruction by a gallstone. The diagnosis of this condition is not difficult. Nevertheless, if treatment is delayed, high morbidity and mortality rates result. Comprehensive treatment aims to relieve the obstruction, to close the biliodigestive fistula and to prevent further gallbladder complications. The surgeon who deals with this type of illness should tailor the treatment plan according to the age, general condition, and intraoperative findings of the individual patient. This paper presents a case report of an 88-year-old woman with gastric outlet obstruction caused by a gallstone. 相似文献
20.
Small Bowel Obstruction Due to Enterolith (Bezoar) Formed in a Duodenal Diverticulum: A Case Report and Review of the Literature 总被引:5,自引:0,他引:5
Everett Shocket M.D. Steven A. Simon M.D. 《The American journal of gastroenterology》1982,77(9):621-624
An elderly patient with an acute small bowel obstruction due to an enterolith that evolved within a duodenal diverticulum is reported. Twenty-four prior instances of small bowel obstruction due to an enterolith formed within a small bowel diverticulum have been culled from the world literature and tabulated, In toto , 18 subjects are female and seven are male. The median age is 68 yr. Optimal surgical management is either to break up the enterolith and milk the components into the cecum without an enterotomy or., as is more often necessary, to milk the enterolith orad removing the concretion through an enterotomy made in less edematous small intestine. As in managing gallstone ileus, the bowel should be "run" seeking additional enteroliths. The diagnosis can be established only by documenting the normalcy of the gallbladder and the presence of duodenal and/or jejunal diverticula. 相似文献