RESUMEN
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.
Asunto(s)
Colelitiasis/complicaciones , Colonoscopía , Enfermedades del Íleon/etiología , Válvula Ileocecal/patología , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Anciano , Anciano de 80 o más Años , Colelitiasis/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Enfermedades del Íleon/diagnóstico , Enfermedades del Íleon/terapia , Obstrucción Intestinal/terapiaRESUMEN
BACKGROUND: Accurate measurement of polyp size during colonoscopy is important because of the direct correlation of size with colon cancer. Major studies of colorectal neoplasms have measured polyp size differently. It is also well documented that endoscopists underestimate polyp size frequently. The goal of this prospective study was to determine which one of the five methods of estimating polyp size during colonoscopy is most accurate. METHODS: One hundred colon polyps were measured by means of visual estimation, open biopsy forceps methods, linear probe, a ruler immediately after excision, and after fixation in formalin. The size of the polyps measured outside the body immediately after excision was considered the "gold standard" against which all measurements were compared. RESULTS: Forty-seven polyps were 5 mm or less in diameter, 33 polyps were 5.01 mm to 10 mm, and 20 polyps were more than 10 mm in size. For all polyps the mean difference versus the actual size of the polyps was 3.4% for linear probe, 6.4% for visual estimation, and 12.3% for the forceps. CONCLUSION: Measurement of polyp size by linear probe agreed best with the actual polyp size, followed closely by visual estimation. The open biopsy forceps method was the least accurate.