Assuntos
Cálculos Biliares/complicações , Íleus/complicações , Obstrução Intestinal/etiologia , Idoso de 80 Anos ou mais , Feminino , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Íleus/diagnóstico por imagem , Íleus/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgiaRESUMO
OBJECTIVE: We report on a patient with gallstone ileus and cholecystoduodenal fistula at the Hospital de Especialidades, Centro Medico Nacional Siglo XXI (IMSS) Mexico City, Mexico. CLINICAL CASE: A 54-year-old male patient was admitted to the hospital with a diagnosis of acute cholecystitis. He had undergone an appendectomy at 34 years of age. There was no history of biliary disease. He was afebrile, with moderate abdominal distention and right upper quadrant pain, Murphy (+). His white blood cell count was 8,900/mm(3) with 40% bands. His liver function tests, amylase and lipase, were all within normal limits. Ultrasound revealed edema and thickening of the gallbladder wall with calculi. He underwent exploratory surgery, which provided the following findings: sclerotrophic gallbladder with intense surrounding inflammation. We therefore decided to perform a cholecystostomy. Two days postoperatively the patient presented abdominal distention and vomiting as well as the presence of intestinal material through the cholecystostomy catheter. Plain abdominal film showed the bowel to be dilated and an aberrantly located gallstone. Cholecystography was performed and showed a cholecystoduodenal fistula. Computed tomography was carried out and disclosed the bowel to be slightly dilated and with an intraluminal gallstone. A laparotomy with enterolithotomy was performed. Sized of the gallstone found was approximately 3 cm. Presently the patient is asymptomatic.
Assuntos
Fístula Biliar/diagnóstico , Colecistolitíase/diagnóstico , Íleus/diagnóstico , Fístula Intestinal/diagnóstico , Fístula Biliar/complicações , Colecistolitíase/complicações , Humanos , Íleus/complicações , Fístula Intestinal/complicações , Masculino , Pessoa de Meia-IdadeRESUMO
AIM: The aim of this study is to describe our experience in the diagnosis and treatment of gallstone ileus, as well as the morbility and mortality associated to this pathology. BACKGROUND: The first description of gallstone ileus was made by Bartholin in 1645 during a post-mortem study. It is a rare pathology, the preoperative diagnosis is difficult and controversy exists in the management that should be carried out on first instance, whether the extraction of the gallstone or the correction of the fistula which can affect outcome. METHODS: We made a case series study in which we studied a total of 25 patients in a 14 years period (1989-2003) with diagnosis of gallstone ileus, patients excluded were those with cholecystoduodenal fistula without gallstone ileus. The variables analyzed were: age, sex, preoperative and postoperative diagnosis, treatment and postoperative morbidity and mortality. RESULTS: Twenty, five patients were studied with diagnosis of gallstone ileus (20 women and 5 men) The median age was 64 (rage 41 to 99). The cholecystoenteric fistula is the most frequently was the cholecystoduodenal in 23. cases (92%) one coledocoduodenal (4%) and one cholecystogastric (4%). The most common site of obstruction was the terminal ileon in 96%. There was a morbility of 20% and the mortality in 7%. CONCLUSION: Gallstone ileus is a rare entity, with only 25 cases reported in a 14 years period in our hospitals. Initial surgical treatment should be guided to the correction of the obstruction and should be considered in a second stage the correction of the fistula, if the patient does not develop symptoms it is not necessary, decreasing morbidity and mortality.
Assuntos
Cálculos Biliares/cirurgia , Íleus/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Cálculos Biliares/complicações , Humanos , Íleus/complicações , Fístula Intestinal/complicações , Masculino , Pessoa de Meia-IdadeRESUMO
We discuss the case of a man with an unusual complication of gallstone disease. An 85-year-old patient presented to the emergency department with a 3-week history of abdominal pain in the right upper abdominal quadrant. Thoracoabdominal radiography demonstrated that the whole extrahepatic biliary tree, including the common bile duct, common hepatic duct, gallbladder, and left and right hepatic ducts, were visibly delineated by air. The operative findings revealed a small shrunken gallbladder, a fistula between the gallbladder fundus and the gastric antrum, and a cholecystohepatic fistula, corresponding to Mirizzi syndrome, type II. A large gallstone was found impacted in the jejunum. This patient seems to have developed initially a cholecystohepatic fistula. Due to the acute inflammatory process, the stone eroded through the gallbladder wall and into the gastric antrum, passing from the antrum into the small bowel, where it became impacted. We suggest that the natural history of Mirizzi syndrome does not end with a cholecystobiliary fistula but that the continuous inflammation in the triangle of Calot may result in a complex fistula involving not only the biliary tract but also the adjacent viscera.
Assuntos
Fístula Biliar/cirurgia , Doenças do Ducto Colédoco/cirurgia , Cálculos Biliares/cirurgia , Íleus/cirurgia , Doenças do Jejuno/cirurgia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Idoso , Fístula Biliar/diagnóstico por imagem , Doenças do Ducto Colédoco/diagnóstico , Seguimentos , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico por imagem , Humanos , Íleus/complicações , Íleus/diagnóstico por imagem , Doenças do Jejuno/diagnóstico por imagem , Laparotomia/métodos , Masculino , Radiografia , Medição de Risco , Índice de Gravidade de Doença , Síndrome , Resultado do TratamentoRESUMO
Racional - a síndrome de Peutz-Jeghers é um distúrbio hereditário autossômico dominante caracterizado por pólipos hamartomatoses intestinais associados a máculas melanocíticas cutaneomucosas e que frequentemente requerem intervenções cirúrgicas para tratamento de suas principais complicações (oclusão, perfuração e sangramento). Relato de caso - adolescente masculino de 17 anos com história anterior de intussuscepção, episódios repetidos de sub-oclusão intestinal e emagrecimento de aproximadamente 10 kg nos últimos quatro meses / Background - the Peutz-Jegher's sndrome is an autosomal dominant inherited disorder characterized by hamartomatous gastrointestinal polyps and mucocutaneous pigmentation. This syndrome usually requires surgical treatment for its complications. Case report - a 17 years old patient with previous history of intussusception, intestinal sub-oclusion and weight lost of 10 kg in the last four months was admitted to the hospital...