Resolution of Gallstone Ileus with Spontaneous Evacuation of Gallstone: A Case Report

Gallstone ileus is an infrequent complication of cholelithiasis. The formation of a fistula between the gallbladder and duodenum may allow a gallstone to enter the gastrointestinal (GI) tract. Gallstone ileus generally occurs in the elderly patients and is associated with significant mortality. Spontaneous resolution of gallstone ileus after passage of gallstone per rectally, though rare, has been reported Farooq et al. (Emerg Radiol 4(6):421–423, 2007). We describe a 60-year-old woman who presented with a 3-day history of vomiting, pain, distension and constipation .Radiological investigations revealed dilatation of small bowel loops with multiple air fluid levels with a large lamellated radio-opaque density measuring 4.4 cm × 4 cm seen in the right iliac fossa. A possibility of gallstone ileus was kept. Because of co-morbid conditions (post-myocardial infarct with cardiac failure), surgery could not be done and patient was kept on conservative management. Three days later patient had sudden relief of her symptoms after passing a large calculus per rectally suggesting a spontaneous evacuation of gallstone. This case highlights the possibility of spontaneous resolution of gallstone ileus after the passage of gallstone. It has been reported in stones less than 2.5 cm. However, to the best of our knowledge, this is the first time in which a large stone measuring 4 cm × 3.8 cm passed spontaneously.     

Gallstone Ileus: Diagnosis and Management

BACKGROUND: Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. It accounts for 1%-4% of mechanical bowel obstruction and is associated with high morbidity and mortality. We present our experience of gallstone ileus and discuss current opinion as reported in the literature. PATIENTS AND METHODS: A retrospective review was performed of medical records of patients in our institution coded for gallstone ileus by the International Classification of Diseases (ICD K-563) coding system between January 1998 and December 2005. RESULTS: There were 22 patients with mean age of 77 (58-92) years and a female to male ratio of 4.5:1. Most patients presented with abdominal pain and vomiting, with a median duration of symptoms of 3 (1-28) days. Preoperative diagnosis was made in 77% from a combination of plain x-ray, ultrasonography, and computed tomography (CT) scans; 86.4% of the patients belonged to ASA class of 3 or 4. Twenty patients underwent enterolithotomy alone, and two had one-stage procedure. The mean size of impacted stones was 3.6 (2.5-4.5) cm, with location in the terminal ileum in 17 and jejunum in 5 patients. There were 5 perioperative deaths and an episode of cholangitis occurring in one patient 18 months after enterolithotomy alone. CONCLUSIONS: Gallstone ileus is a difficult clinical entity to diagnose. Unreserved use of imaging techniques can improve diagnostic accuracy and speed of therapeutic decision making. Management of gallstone ileus must be individualized. The one-stage procedure should be offered only to highly selected patients with good cardiorespiratory reserve and with absolute indications for biliary surgery at the time of presentation.     

Comparison of Surgical Treatments of Gallstone Ileus: Preliminary Report

Abstract Gallstone ileus is an uncommon cause of small bowel obstruction, accounting for only 1% to 4% of all intestinal obstructions. In the group of patients over 65 years of age, gallstones cause about 25% of all non-strangulated obstructions of the small bowel. Gallstone ileus is burdened with high mortality rate, ranging from 12% to 18%, and most patients are of advanced age, with many other concomitant diseases that may increase the operative risk. The purpose of this study was to compare the two investigated surgical procedures: treatment of intestinal obstruction alone or combined with urgent cholecystectomy and fistula repair. Analysis of 30 patients undergoing operation for gallstone ileus at the Clinical Hospital “Sestre milosrdnice” between 1985 and 2001 is presented. Patients were treated either for ileus alone (group 1, 11 patients) or as one-stage procedure with urgent fistula closure (group 2, 19 patients). Operating time was significantly longer for the one-stage procedure. Complications occurred in 3 of 11 patients (27.3%) from group 1 and in 11 of 18 patients (61.1%) from group 2 (one tailed, p = 0.043). One patient in group 1 died and two patients in group 2 died. Urgent fistula repair was significantly associated with the occurrence of complications (odds ratio [OR] 12.1, 95% confidence internal [95% CI] 1.2–121.5). Simple enterotomy should be the procedure of choice for patients with gallstone ileus. The one-stage procedure including urgent fistula repair should be reserved only for highly selected patients with absolute indications.     

Gallstone Ileus After Biliointestinal Bypass: Report of Two Cases

Introduction

Gallstone ileus is an uncommon disease and accounts for 1–4 % of all cases of mechanical intestinal obstruction. The physiopathology is related to the presence of a bilioenteric fistula.

Method

We report two cases of gallstone ileus in patients operated on biliointestinal bypass for morbid obesity. The anastomosis of the gallbladder to the proximal end of the bypassed jejunum allowed the transit of gallstones in the excluded ileum and its impaction in anti-reflux valvular system.

Results

Preoperative exams were unable to solve the diagnostic query, and the diagnosis was achieved only at laparotomy. One-stage combined enterolithotomy and cholecystectomy were performed.

Conclusion

The two patients had an uneventful recovery. To our knowledge, this is the first report of gallstone ileus after biliointestinal bypass.     

胆石性肠梗阻的诊治(附11例临床分析)

目的探讨胆石性肠梗阻的临床特点和治疗方法. 方法我院1985年～2000年共收治胆石性肠梗阻11例,术前仅3例确诊.均经手术治疗,其中10例行肠管切开取石,1例因肠坏死切除坏死肠段.失访2例,余9例患者一期术后6～9月行胆囊切除和(或)内瘘修补术. 结果Ⅰ期手术后并发呼吸道感染2例,切口感染1例,随访结果显示Ⅱ期手术后9例患者均获治愈. 结论胆石性肠梗阻术前确诊率低,但及时的B超及X线检查有助于其早期诊断,分期手术治疗胆石性肠梗阻效果显著.     

A Rare Complication after Thyroidectomy: Perforation of the Oesophagus: a Case Report

Perforation of the cervical oesophagus after thyroidectomy is an exceptionally rare complication. Total thyroidectomies, particularly for recurrent cases might possess an increased risk. Although rare, it has high mortality and morbidity. A patient that developed oesophagus perforation after a total thyroidectomy in a peripheral hospital for recurrent nodular goitre was treated and followed-up in our clinic. This well-documented case is discussed in conjunction with the information presented in the literature.     

胆石性肠梗阻16例分析

目的:探讨胆石性肠梗阻的临床特点和诊治方法.方法:术前经腹部超声、X线平片和螺旋CT检查,确诊9例.1例经中西医结合非手术治疗排出结石,15例行手术治疗.结果:术后并发切口感染3例,肺感染2例,急性心功能不全1例,均治愈.结论:胆石性肠梗阻术前确诊困难,腹部超声及螺旋CT有助于早期明确诊断.肠管切开取石术在多数患者是首选的治疗方法.     

Spermatocele: A Rare Complication of Rectal Surgery and Radiotherapy Case Report

A 47-year-old man developed a presacral mass after abdominoperineal resection, which is combined with pre and postoperative radio-chemotherapy for carcinoma of the rectum. CT-guided biopsy and cytological examination of the mass revealed no malignancy but spermatocele, which is a very unusual complication of rectal surgery.     

Giant Mesenteric Lipoma as a Rare Cause of Ileus in a Child: Report of a Case

Mesenteric lipoma is a rare benign tumor of mature fat cells. Although generally asymptomatic, it occasionally causes abdominal pain, ileus, and small bowel volvulus, depending on its location and size. A definitive diagnosis can be made by pathological examination. Ultrasonography and abdominal computed tomography show this lesion as a well-defined, homogeneous mass with fat density surrounded by a thin capsule. Because of its rare etiologic origin, we report the case of a 7-year-old girl with a mass in the abdomen and ileus, found to be caused by a mesenteric lipoma.     

Muir-Torre Syndrome Presenting with Ileus: a Case Report

The Muir-Torre syndrome is characterized by cutaneous neoplasms and visceral malignancies. At least one sebaceous adenoma, epithelioma or carcinoma and at least one internal malignancy are required to make a reliable diagnosis. According to medical literature only two cases of Muir-Torre syndrome with jejunal carcinoma have been reported to date and there is no reported case with intestinal obstruction. Here, we report an unusual case of jejunal carcinoma presenting with ileus.     

Laparoscopically Assisted Surgery for Colonic Perforation with Peritonitis - A Case Report

Elective laparoscopic colonic surgery is increasingly recognized as feasible and perhaps preferential. A case of laparoscopically assisted surgery for trauma to the rectum with bacterial peritonitis is presented. It presents an example of the application of this modality to the treatment of iatrogenic colon perforations and perhaps selected diverticulitis.     

Primary Choriocarcinoma of the Jejunum: Report of a Case

We report a case of primary choriocarcinoma of the jejunum in a 45-year-old man, which was finally diagnosed by immunohistochemical analysis of a surgically resected specimen. Despite combined systemic chemotherapy, the patient died of progressive liver metastases 5 months after surgery. The serum human chorionic gonadotropin (HCG) level increased dramatically as the liver tumor progressed. According to our review of the 13 cases of primary or secondary choriocarcinoma of the small intestine reported in the English-language literature up until 2001, the characteristic symptoms are massive gastrointestinal bleeding and elevation of the serum HCG. Early diagnosis and prompt initiation of chemotherapy provide the only chance of improving the extremely poor prognosis associated with this rare neoplasm.     

Tuberculous Gastric Perforation: Report of a Case

A 21-year-old woman presented with a 2-day history of acute abdominal pain. Contrast-enhanced computed tomography (CT) showed a perforation in the lesser curve of the stomach. The patient suffered a bout of hematemesis, following which an endoscopy showed a bleeding blood vessel at the edge of the perforation. We performed an emergency distal gastrectomy, including the ulcer site. Histopathological examination revealed tuberculous granulation tissue and acid-fast bacilli in the ulcer. The patient was given antituberculosis therapy (ATT) postoperatively, and was well when last seen 1 year 5 months after surgery. We analyzed the clinical data of five cases of tuberculous gastric perforation (TGP), reported between 1948 and 2003, including our patient. The patients ranged in age from 21 to 45 years, with a mean age of 36.8 years (SD ± 10.21), and a male to female ratio of 3:2. The diagnosis was confirmed by surgery or autopsy. Abdominal lymphadenopathy was present in all patients. Gastrectomy was performed in four patients, and two were given ATT. All four patients in the previous reports died of their disease.     

Duodenal Ulcer Perforation and Pneumothorax: a Case Report

Pneumothorax and pneumomediastinum are rarely observed as a complication of perforated peptic ulcer, which is a common cause of acute abdomen. We report a case of a 30-year-old male patient with abdominal pain and respiratory distress. Resulting from physical examination and laboratory data of the patient, acute abdomen and pneumothorax were diagnosed simultaneously. Laparotomy revealed duodenal ulcer perforation and a simple patch closure was performed. No complications were observed during the postoperative course of the patient.     

Spontaneous Perforation of Acalculous Gallblader: A Case Report

Main cause of gallbladder perforation is cholecystitis with or without stones. In old age, spontaneous perforation of gallbladder can be due to decreased blood supply which can be as the result of atherosclerosis, focal vasospasm or localized vasculitis. Perforation is associated with high morbidity and mortality if left untreated. Here, we report a rare case of idiopathic and spontaneous perforation of gallbladder in a 77 years old lady.     

Postoperative Necrotizing Chest-wall Infection: Case Report of a Rare Complication after Elective Lung Surgery

Necrotizing fasciitis, an uncommon, often fulminant bacterial infection, rarely originates in the chest wall. In a 67-year-old woman, elective lower lobectomy of the right lung was followed by fatal necrotizing fasciitis of the chest wall. Tissue necrosis and overwhelming sepsis were due to synergistic infection by Staphylococcus aureus and Streptococcus microaerophilica. As the early appearance of necrotizing fasciitis is deceptively benign, the diagnosis is extremely difficult and is reliant on a high index of suspicion. Prompt surgical intervention is essential.     

Metastatic Osteosarcoma in the Jejunum with Intussusception: Report of a Case

We report a case of metastatic osteosarcoma in the jejunum causing intestinal intussusception. A 58-year-old woman underwent right femoral region amputation, lower lobectomy of the left lung and complete left pneumonectomy after four courses of chemotherapy for osteosarcoma of the right femur with left lung metastases. She was referred to our department 13 months later with progressive abdominal pain and vomiting. Abdominal radiography showed a small-bowel obstruction. She underwent emergency laparotomy, which revealed jejunal intussusception. The lead point was found to be an intraluminal tumor. We resected the jejunum containing the tumor and histological examination confirmed that the tumor was osteosarcoma metastasis.