A single centre case series of gallstone sigmoid ileus management

Aims/IntroductionGallstone sigmoid ileus is a rare condition that presents with symptoms of large bowel obstruction secondary to a gallstone impacted within the sigmoid colon. This arises because of three primary factors: cholelithiasis causing a cholecystoenteric fistula; a gallstone large enough to obstruct the bowel lumen; and narrowing of the bowel.We describe 3 patients treated in a district general hospital over a 3-year period, and discuss their management.MethodsCases were retrospectively analysed from a single center between 2015 and 2017 in line with the SCARE guidelines.Results3 patients – 2 female, 1 male. Age: 89, 68, 69 years. 2 cholecystocolonic fistulae, 1 cholecystoenteric (small bowel) fistula.Patient 1: Unsuccessful endoscopic attempts to retrieve the (5 × 5 cm) gallstone resulted in surgery. Retrograde milking of the stone to caecum enabled removal via modified appendicectomy.Patient 2: Endoscopy and lithotripsy failed to fragment stone. Prior to laparotomy the stone was palpated in the proximal rectum enabling manual extraction.Patient 3: Laparotomy for gallstone ileus failed to identify a stone within the small bowel. Gallstone sigmoid ileus then developed. Conservative measures successfully decompressed the large bowel 6 days post-operation.ConclusionsThis is the first case series highlighting the differing strategies and challenges faced by clinicians managing gallstone sigmoid ileus. Conservative measures (including manual evacuation), endoscopy, lithotripsy and surgery all play important roles in relieving large bowel obstruction. It is essential to tailor care to individual patients’ needs given the complexities of this potentially life threatening condition.     

Gallstone ileus one quarter of a century post cholecystectomy

Gallstone ileus is a rare but potentially serious complication of cholelithiasis. It is usually preceded by history of biliary symptoms. It usually occurs as a result of a large gallstone creating and passing through a cholecysto-enteric fistula. Most of the time, the stone will pass the GI tract without any problems, but large enough stones can cause obstruction. The two most common locations of impaction are the terminal ileum and the ileocaecal valve because of the anatomical small diameter and less active peristalsis. We present an unusual case of small bowel obstruction secondary to gallstone ileus 24 years after an open cholecystectomy.     

豚鼠体内生长抑素和血管活性肠肽在胆囊结石形成中的作用

目的 探讨体内生长抑素和血管活性肠肽在胆囊结石形成中的作用。方法 采用放射免疫分析法（ＲＩＡ）和受体放射配基结合分析法（ＲＢＡ）分别测定豚鼠体内门静脉血产乐、胆囊壁组织、胆汁中的ＳＳ、ＶＩＰ和胆囊壁上ＶＩＰ受体（ＶＩＰ－Ｒ）。与对照组比较观察在诱发豚鼠胆囊结石实验的第２、６、８周后胆空腹体积（ＦＶ）、胆囊空腹胆汁量（ＦＢ）、胆汁成分及上述胃肠肽的变化。结果 实验２周后ＦＶ增大,５６周和８周后ＦＢ亦     

胆道癌、胆石症患者胆汁标本菌群分析

目的 探讨胆石症发病与细菌感染的关系.方法采用需氧、专性厌氧和微需氧方法 对择期手术治疗的胆道癌、胆石症患者的胆汁标本进行细菌分离培养、API鉴定和菌群分析.结果 胆石症患者细菌阳性分离率为36%（34/95）,胆石症合并胆道癌患者为43%（6/14）,胆道癌患者为57%（8/14）;色素型胆石症患者胆汁细菌阳性分离率为77%（10/13）,混合型胆石症患者为29%（16/56）,胆固醇型胆石症患者为23%（3/13）,不明胆石类型胆石症患者为45%（10/22）.共分离出69株菌株,其中肠杆菌科细菌30株,肠球菌属细菌19株,其余为葡萄球菌属细菌、链球菌属细菌等.结论 胆石症患者胆汁中分离出细菌,且以色素型胆石症患者胆汁标本细菌阳性分离率最高,胆汁细菌分布又以肠杆菌科细菌和肠球菌属为主,提示色素型胆石症形成与细菌有一定关系.     

胆道术中造影临床应用体会

[目的]　探讨应用胆道术中造影对发现残留结石,提高胆道结石清除率的可行性。　[方法]　2000年1月至2002年12月,共施行选择性胆道造影95例,其中胆囊管造影73例,胆总管造影22例。　[结果]　胆囊管造影73例中,发现15例胆总管结石;胆总管造影22例中,发现4例残留结石。　[结论〗　胆道术中造影可减少常规胆总管探查,提高发现胆石残留的概率。     

术前口服碳水化合物对胆囊结石微创手术围术期应激反应及术后胃肠功能恢复的影响

目的 探讨术前口服碳水化合物对胆囊结石微创手术围术期应激反应及术后胃肠功能恢复的影响.方法 对河南省直第三人民医院2019年6月至2020年4月收治的71例胆囊结石实施腹腔镜下胆囊切除术病人临床资料进行回顾性分析,其中有34例术前未口服碳水化合物(记为常规组),余37例术前口服碳水化合物(记为饮品组).对比术前6 h、...     

腹腔镜胆囊切除术治疗急性结石性胆囊炎的体会

目的总结腹腔镜胆囊切除术（LC）治疗急性结石性胆囊炎的临床经验和手术操作技巧。方法回顾性分析我院2006年9月～2010年7月行LC的103例急性结石性胆囊炎患者的临床资料。结果 LC成功率91.26%（94/103）,中转开腹率8.74%（9/103）,并发症发生率1.94%（2/103）。结论急性结石性胆囊炎行LC是安全可行的,正确处理胆囊三角是成功的关键,适时中转开腹是手术安全的保障。     

Ileal gallstone obstruction: Single-balloon enteroscopic removal

Gallstone-induced ileus is a rare complication of cholelithiasis. Since localization of gallstones impacted in the small bowel, especially in the ileum, prevents access by conventional endoscopy in most cases, the mainstay of treatment remains surgical. Recent invention of double- and single-balloon enteroscopy has added much to the ability of imaging the small bowel and enables endoscopically directed therapy. Herein, for the first time, we report a successful endoscopic calculus removal via peroral single-balloon enteroscopy in an 81-year-old woman suffering from gallstone ileus of the ileum.     

腹腔镜治疗胆囊结石急性发作58例临床治疗观察

目的探讨腹腔镜治疗胆囊结石急性发作的临床治疗效果。方法回顾行分析我院收治的58例胆囊结石患者,采用腹腔镜手术治疗,分析其治疗效果。结果患者均手术顺利,无切口感染,无严重并发症,均康复出院,住院时间7～14d,治愈率91.4%。出院后随访90d,无任何不适情况。结论腹腔镜胆囊切除术是治疗胆囊结石的安全、有效的方法,值得在临床中广泛使用。