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Pesce A, Lauro A, Gonella Pacchiotti C, D'Andrea V, Fabbri N, Bertasi M, Feo CV. Like a Rolling (Gall)Stone: Optimal Treatment of Gallstone Obstruction of the Sigmoid Colon. Dig Dis Sci 2024; 69:1593-1601. [PMID: 38466460 PMCID: PMC11098863 DOI: 10.1007/s10620-024-08328-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Sigmoid gallstone ileus is a rare complication of cholelithiasis, accounting for 1-4% of all cases of large-bowel obstruction. This is a highly morbid, and often fatal, condition due to its challenging diagnosis and late presentation. CASE PRESENTATION We report a case of a 90-year-old woman admitted to Emergency Department with abdominal pain and large-bowel obstruction due to a 6 cm gallstone lodged in a diverticulum of the proximal sigmoid colon as a consequence of a cholecysto-colonic fistula. Colonoscopy was deferred due to gallstone size carrying a high possibility of failure. The patient underwent urgent laparotomy with gallstone removal via colotomy. The cholecystocolonic fistula was left untreated. The post-operative course was uneventful; the patient was discharged on 6th post-operative day. CONCLUSION A multidisciplinary discussion between endoscopists and surgeons is often needed to choose the best therapeutic option, especially in high-risk patients.
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Affiliation(s)
- Antonio Pesce
- Unit of General Surgery, Department of Surgery, "Azienda Unità Sanitaria Locale" of Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, FE, Italy.
| | - Augusto Lauro
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Costanza Gonella Pacchiotti
- Unit of General Surgery, Department of Surgery, "Azienda Unità Sanitaria Locale" of Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, FE, Italy
| | - Vito D'Andrea
- Department of Surgery, "Sapienza" University of Rome, V.Le Regina Elena 324, 00161, Rome, Italy
| | - Nicolò Fabbri
- Unit of General Surgery, Department of Surgery, "Azienda Unità Sanitaria Locale" of Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, FE, Italy
| | - Mario Bertasi
- Unit of General Surgery, Department of Surgery, "Azienda Unità Sanitaria Locale" of Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, FE, Italy
| | - Carlo Vittorio Feo
- Unit of General Surgery, Department of Surgery, "Azienda Unità Sanitaria Locale" of Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, FE, Italy
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Xu A, Kong C, Li J. Gallstone ileus due to cholecystoenteric fistula accompanied by diabetes mellitus. Am J Med Sci 2024; 367:e33-e34. [PMID: 37980968 DOI: 10.1016/j.amjms.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Aihua Xu
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Chaonan Kong
- Department of Radiology, Rushan Hospital of Traditional Chinese Medicine, Rushan, Shandong, China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China.
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Wang CY, Chiu SH, Chang WC, Ho MH, Chang PY. Cholecystoenteric fistula in a patient with advanced gallbladder cancer: A case report and review of literature. World J Clin Cases 2023; 11:8519-8526. [PMID: 38188217 PMCID: PMC10768506 DOI: 10.12998/wjcc.v11.i36.8519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/12/2023] [Accepted: 12/07/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Cholecystoenteric fistula (CEF) involves the formation of a spontaneous anomalous tract between the gallbladder and the adjacent gastrointestinal tract. Chronic gallbladder inflammation can lead to tissue necrosis, perforation, and fistulogenesis. The most prevalent cause of CEF is chronic cholelithiasis, which rarely results from malignancy. Because the symptoms and laboratory findings associated with CEF are nonspecific, the condition is often misdiagnosed, presenting a challenge to the surgeon when detected intraoperatively. Therefore, a preoperative diagnosis of CEF is crucial. CASE SUMMARY We present the case of a 57-year-old male with advanced gallbladder cancer (GBC) who arrived at the emergency room with persistent vomiting, abdominal pain, and diarrhea. An abdominopelvic computed tomography scan revealed a contracted gallbladder with bubbles in the fundus connected to the second portion of the duodenum and transverse colon. We suspected that GBC had invaded the adjacent gastrointestinal tract through a cholecystoduodenal fistula (CDF) or a cholecystocolonic fistula (CCF). He underwent multiple examinations, including esophagogastroduodenoscopy, an upper gastrointestinal series, colonoscopy, and magnetic resonance cholangiopancreatography; the results of these tests confirmed a diagnosis of synchronous CDF and CCF. The patient underwent a Roux-en-Y gastrojejunostomy and loop ileostomy to address the severe adhesions that were previously observed to cover the second portion of the duodenum and hepatic flexure of the colon. His symptoms improved with supportive treatment while hospitalized. He initiated oral targeted therapy with lenvatinib for further anticancer treatment. CONCLUSION The combination of imaging and surgery can enhance preoperative diagnosis and alleviate symptoms in patients with GBC complicated by CEF.
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Affiliation(s)
- Chun-Yu Wang
- Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Sung-Hua Chiu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Meng-Hsing Ho
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Ping-Ying Chang
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
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Alsairy S, Alessa AM, Alaiyar BN, Alharbi O, Alomar A, Albalawi S, Almalki B, AlRikhaimi A. Incidentally Found Cholecystoduodenal Fistula and an Unusual Case of Gallstone Ileus After Laparoscopic Cholecystectomy. Cureus 2023; 15:e49651. [PMID: 38161804 PMCID: PMC10756161 DOI: 10.7759/cureus.49651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Gallstone ileus, a rare and potentially fatal complication of cholelithiasis, occurs when gallstones breach the gastrointestinal tract through a fistula, causing an obstruction and potentially leading to severe complications. This case report details the experience of a 44-year-old woman with gallstone ileus stemming from an unnoticed cholecystoduodenal fistula following a routine cholecystectomy. The fistula was only discovered during surgery despite advanced imaging, revealing extensive adhesions. The discovery led to a subtotal cholecystectomy and fistula repair. Postoperatively, complications arose, prompting a computed tomography scan to rule out further issues. However, she later returned with gallstone ileus, necessitating a second operation. This case underscores the importance of thorough intraoperative exploration for biliary enteric fistulas during cholecystectomy, potentially averting the need for subsequent interventions. The case also highlights the diagnostic challenges of gallstone ileus and the significance of clinical suspicion.
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Affiliation(s)
| | | | | | - Osama Alharbi
- Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | - Sakhar Albalawi
- Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Bader Almalki
- Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Walia DJS, Singla A, Singh S, Dua J. A Rare Case of Cholecystoduodenal and Cholecystocolic Fistula with Gallstone Ileus. Int J Appl Basic Med Res 2023; 13:121-123. [PMID: 37614840 PMCID: PMC10443450 DOI: 10.4103/ijabmr.ijabmr_598_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 08/25/2023] Open
Abstract
Cholecystoduodenal and cholecystocolic fistula (CCF) is a rare condition, occurring in patients with cholelithiasis. Multiple complex fistulas are even rare. This is a case study done to detail such a rare case, very few such cases have been reported in the past studies, with cholecystoduodenal and CCF with gallstone ileus. We present the case of an 80-year-old, female diagnosed with intestinal obstruction. Intraoperatively, the gallbladder (GB) fundus forms a CCF and the body of the GB with the first part of the duodenum forms cholecystoduodenal fistula. Gallstone ileus found impacted in jejunum 35 cm distal to DJ junction. Resection of fistula tracts with primary repair of the transverse colon was done with Graham's patch repair of duodenum and fundus first cholecystectomy. Cholecysto-duodeno-colic fistulas complicated with gallstone ileus are very rare. In the case of gallstone ileus, the surgical treatment is an emergency and the only therapeutic option.
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Affiliation(s)
| | - Anand Singla
- Department of General Surgery, GMC and Rajindra Hospital, Patiala, Punjab, India
| | - Sandeep Singh
- Department of Medicine, GMC and Rajindra Hospital, Patiala, Punjab, India
| | - Jasmeen Dua
- Department of Medicine, GMC and Rajindra Hospital, Patiala, Punjab, India
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Liu YY, Bi SY, He QR, Fan Y, Wu SD. Developments in the Diagnosis and Management of Cholecystoenteric Fistula. J INVEST SURG 2022; 35:1841-1846. [PMID: 36167340 DOI: 10.1080/08941939.2022.2113188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis. CEF refers to one or more pathological perforations between the gallbladder and the adjacent gastrointestinal tract, first described by Bartholin in 1645. The aim of this review is to examine the etiology, symptoms, diagnosis, and treatment of CEF.Methods: A literature search was conducted according to a set of criteria in PubMed for historical and current peer-reviewed studies regarding CEF.Results: Clinical manifestations of CEF are always latent. Despite modern imaging studies and diagnostic methods, it is still very difficult to definitively diagnose CEF preoperatively. Instead, CEF is often accidentally discovered in the perioperative period or via intraoperative exploration.Conclusions: Without appropriate preoperative preparation, gastrointestinal injury and intraoperative bleeding often occur. CEF often goes unreported, and its diagnosis and treatment are still controversial. Early diagnosis of CEF is essential for effective treatment and improved outcome.
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Affiliation(s)
- Ying-Yu Liu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shi-Yuan Bi
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Quan-Run He
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ying Fan
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shuo-Dong Wu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Huang SF, Han YH, Chen J, Zhang J, Huang H. Surgical Management of Cholecystoenteric Fistula in Patients With and Without Gallstone Ileus: An Experience of 29 Cases. Front Surg 2022; 9:950292. [PMID: 35874133 PMCID: PMC9304664 DOI: 10.3389/fsurg.2022.950292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/24/2022] [Indexed: 12/17/2022] Open
Abstract
Background Cholecystoenteric fistula (CEF) is an uncommon complication of cholelithiasis. Here, we report our experience on diagnostic methods and surgical management of CEF patients with and without gallstone ileus (GI). Methods This is a retrospective cases series over an 11-year period (2011–2022). Data analyzed included preoperative characteristics, ultrasound, imaging features, operation findings and postoperative course. Results A total of 29 patients diagnosed with CEF were enrolled, 51.7% (15/29) of whom were female, with a median age of 66 years (range: 35–96 years). With regards to subtype distribution, seventeen patients had cholecystoduodenal fistula (CDF), six had cholecystoconlonic fistula (CCF), three exhibited cholecystogastric fistula (CGF), one CDF combination with CCF and two CDF combination with type I Mirizzi syndrome. Twelve patients presented with gallstone ileus, and received one stage procedure or simple Enterolithotomy. The median operation time and blood loss of 157 min (range: 65–360 min) and 40 ml (range: 10–450 ml), respectively. Surgical complications, evidenced by fistula recurrence, were recorded in three patients (3/22; 13.6%), while four (4/29; 13.8%) and one patient (1/29; 3.4%) presented with wound infection and residual stone in common bile duct, respectively. No deaths were reported in our study. Conclusion CEF is a rare complication of gallstone disease that is occasionally found during operation. To date, no consensus has been reached regarding efficacious treatment therapies for CEF patients. For a CEF patient with GI, one stage procedure should be selected prudently, while simple Enterolithotomy would be a mainstream choice for relieving bowel obstruction.
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Rajput D, Gupta A, Kumar S, Singla T, Srikanth K, Chennatt J. Clinical spectrum and management outcome in gallbladder perforation-a sinister entity: Retrospective study from Sub-Himalayan region of India. Turk J Surg 2022; 38:25-35. [DOI: 10.47717/turkjsurg.2022.5325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/19/2021] [Indexed: 11/23/2022]
Abstract
Objective: Gallbladder perforation is an infrequent entity seen among surgical patients. Rare occurrence owes to difficulty in diagnosing gallbladder perforations. The aim of the present study was to determine the optimal management strategy that may decrease the morbidity and mortality associated with this potentially life-threatening condition.
Material and Methods: This was a retrospective study from hospital health records wherein the experience of 40 consecutive patients with gallbladder rupture, either spontaneous or secondary to both benign conditions and malignancy, was noted at a tertiary care hospital over 48 months from February 2017 till January 2021. The etiology, clinical presentation, and treatment given were analysed.
Results: Out of 40 patients included, 23 were females and the majority of patients were more than 45 years of age. Twelve patients responded to intravenous antibiotics and analgesics alone while five required an ultrasound-guided pigtail catheter drainage due to non-improving clinical condition. The failure of expectant management led to a delayed laparotomy in seven patients while four patients required emergency laparotomy because of generalized peritonitis. An elective cholecystectomy was offered to 12 patients with cholecystoenteric fistulae after diagnostic laparoscopy in the same admission. Thirty-eight patients were discharged in stable condition and doing well at 30-day follow-up.
Conclusion: Gallbladder perforation is seen more commonly in acute calculous cholecystitis compared to other conditions. It is more evident when the treatment of acute calculous cholecystitis is delayed by more than 6-8 weeks. The spectrum of clinical presentation varies from mild pain and vomiting to generalized peritonitis. The patient often requires a step-up approach to control the ongoing sepsis for an improved outcome.
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Abstract
IMPORTANCE Gallbladder disease affects approximately 20 million people in the US. Acute cholecystitis is diagnosed in approximately 200 000 people in the US each year. OBSERVATIONS Gallstone-associated cystic duct obstruction is responsible for 90% to 95% of the cases of acute cholecystitis. Approximately 5% to 10% of patients with acute cholecystitis have acalculous cholecystitis, defined as acute inflammation of the gallbladder without gallstones, typically in the setting of severe critical illness. The typical presentation of acute cholecystitis consists of acute right upper quadrant pain, fever, and nausea that may be associated with eating and physical examination findings of right upper quadrant tenderness. Ultrasonography of the right upper quadrant has a sensitivity of approximately 81% and a specificity of approximately 83% for the diagnosis of acute cholecystitis. When an ultrasound result does not provide a definitive diagnosis, hepatobiliary scintigraphy (a nuclear medicine study that includes the intravenous injection of a radiotracer excreted in the bile) is the gold standard diagnostic test. Following diagnosis, early (performed within 1-3 days) vs late (performed after 3 days) laparoscopic cholecystectomy is associated with improved patient outcomes, including fewer composite postoperative complications (11.8% for early vs 34.4% for late), a shorter length of hospital stay (5.4 days vs 10.0 days), and lower hospital costs. During pregnancy, early laparoscopic cholecystectomy, compared with delayed operative management, is associated with a lower risk of maternal-fetal complications (1.6% for early vs 18.4% for delayed) and is recommended during all trimesters. In people older than 65 years of age, laparoscopic cholecystectomy is associated with lower mortality at 2-year follow-up (15.2%) compared with nonoperative management (29.3%). A percutaneous cholecystostomy tube, in which a drainage catheter is placed in the gallbladder lumen under image guidance, is an effective therapy for patients with an exceptionally high perioperative risk. However, percutaneous cholecystostomy tube placement in a randomized trial was associated with higher rates of postprocedural complications (65%) compared with laparoscopic cholecystectomy (12%). For patients with acalculous acute cholecystitis, percutaneous cholecystostomy tube should be reserved for patients who are severely ill at the time of diagnosis; all others should undergo a laparoscopic cholecystectomy. CONCLUSIONS AND RELEVANCE Acute cholecystitis, typically due to gallstone obstruction of the cystic duct, affects approximately 200 000 people in the US annually. In most patient populations, laparoscopic cholecystectomy, performed within 3 days of diagnosis, is the first-line therapy for acute cholecystitis.
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Affiliation(s)
- Jared R Gallaher
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill
| | - Anthony Charles
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill
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Dowais R, Al Sharie S, Araydah M, Al Khasawneh S, Haddad F, AlJaiuossi A. Pearl-white gallstones: A report of a case and a chemical analysis by FTIR and XRD. Int J Surg Case Rep 2021; 87:106449. [PMID: 34571346 PMCID: PMC8476646 DOI: 10.1016/j.ijscr.2021.106449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction Gallstones' color is usually yellow, brown, black or more commonly a mixture of two or more of these colors in different proportions, depending on their composition, with yellow being the most commonly encountered color. Pearl-white gallstones are a very rare entity that has not been studied and reported sufficiently. Case presentation Our patient is a 44-year-old lady who was suffering from recurrent attacks of epigastric and right hypochondrial abdominal pain that was aggravated by consumption of fatty meals. Ultrasound Imaging revealed multiple gallbladder stones. After an elective cholecystectomy unusual pearl-white gallstones were found inside a distended gallbladder filled with transparent thick fluid. Chemical analysis To evaluate the chemical composition of these stones Fourier-transform infrared (FTIR) spectroscopy and X-Ray Diffraction (XRD) tests were performed and revealed that these stones are composed of cholesterol (99.6%) and calcium carbonate (0.4%). Discussion Gallstones are bile depositions of a solid consistency formed inside the gallbladder. Cholesterol, bilirubin, and other substances are involved in the composition of different kinds of gallstones. The presence of gallstones alone inside the gallbladder is usually presented as colicky abdominal pain. Cholecystectomy is a simple surgical removal of the gallbladder from it bed and is the definitive treatment of gallstone disease. Conclusion Pearl-white gallstones are rarely encountered and lack information about their pathogenesis, thus prompting further evaluation and studying. Pearl-white coloration of gallstones in extremely rare. FTIR and XRD are useful tools to analyze the chemical composition of gallstones. Cholesterol is the major component of pearl-white gallstones.
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Affiliation(s)
- Raad Dowais
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | | | | | | | - Fadi Haddad
- Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Anas AlJaiuossi
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
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Rodriguez JER, Grossi AEDLMT, Siqueira VR, de Siqueira Filho JT, Pereira MAS, da Cunha DGC. Gallstone ileus associated with cholecystogastric fistula: Case report, diagnosis and surgical treatment. Int J Surg Case Rep 2021; 86:106328. [PMID: 34425424 PMCID: PMC8387747 DOI: 10.1016/j.ijscr.2021.106328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction Gallstone Ileus is a rare complication of cholelithiasis, associated with multiple episodes of cholecystitis, with the formation of adhesions and fistulas between the gallbladder and adjacent organs. Its diagnosis is difficult, requiring complementary imaging tests such as computed tomography or radiography. Presentation of case Female patient, with intestinal obstruction for 7 days, associated with abdominal pain and previous episodes of pain in the right hypochondrium for 3 months. Abdominal CT scan identified aerobilia, gallstone impacted in the ileocecal valve and small loop dilatation, in addition to a probable cholecystogastric fistula. Opted for exploratory laparotomy, enterolithotomy and fistula correction in one surgical time. Discussion Gallstone ileus is rare among the complications of cholelithiasis, in addition to the fact that cholecystogastric fistula is associated with gastric pylorus obstruction and not impaction on the ileocecal valve. Imaging tests are useful to complement the diagnosis, and if Rigler's triad is present, the suspicion of gallstone ileus is increased. The presence of fistula between the gallbladder and stomach presents a frequency between 0 and 13.3%. There is no gold standard treatment for gallstone ileus, but surgery options for each type of patient and severity level. Conclusion There is no definitive protocol for optimal surgical treatment for biliary ileus, but the possibility of enterolithotomy associated with cholecystectomy and fistula correction can be evaluated in selected patients. Gallstone ileus is a rare cause of intestinal obstruction. Cholecystogastric fistula may be associated with ileum obstruction. One-step surgical treatment can be used in specific patients
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Affiliation(s)
| | | | | | | | - Magnum Adriel Santos Pereira
- Amazon State Institute of Surgery (ICEA), Manaus, Brazil; Department of General Surgery, Adriano Jorge Hospital Foundation (FHAJ), Manaus, Brazil
| | - Decius Guimarães Carneiro da Cunha
- Amazon State Institute of Surgery (ICEA), Manaus, Brazil; Department of General Surgery, Adriano Jorge Hospital Foundation (FHAJ), Manaus, Brazil
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Martínez Segundo U, Pérez Sánchez A, Sesman Bernal MP, Pérez Burguete AC. Gallstone ileus after recent cholecystectomy. Case report and review of the literature. Int J Surg Case Rep 2021; 79:470-474. [PMID: 33757265 PMCID: PMC7868805 DOI: 10.1016/j.ijscr.2021.01.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Gallstone ileus in cholecystectomized patients is very infrequent and when it happens shortly after surgery is even rarer. We report the case of a patient who presented Gallstone ileus few days after open cholecystectomy which has not been reported before in literature. CASE PRESENTATION A 52-year-old male with a history of recent open cholecystectomy was referred to our center due to a presumable surgical complication. During his hospitalization while trying to restart the oral route he presented abdominal pain and nausea. He evolved toward a bowel obstruction. We suspected gallstone ileus based on medical history as well as preoperative image study. We confirmed the diagnostic using a Computed Tomography. Surgical management was performed and a large gallstone was extracted from the bowel. The patient progressed favorably and was discharged. He was asymptomatic during the follow-up. CLINICAL DISCUSSION Cholecystectomized patients who have been reported with Gallstone ileus demonstrate different pathophysiological mechanisms or extraordinary presentations. This case describes a unique presentation illustrating relevant aspects of this pathology such as showing that acute cholecystitis can be its clinical manifestation or that it could happen after a cholecystoenteric fistula is found during a cholecystectomy. CONCLUSION Gallstone ileus in cholecystectomized patients is very rare. Clinical suspicion remains the cornerstone of diagnosis.
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Affiliation(s)
| | - Antonio Pérez Sánchez
- Department of Surgery, Hospital Regional de Alta Especialidad Ciudad Salud, Chiapas, 30830, México
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13
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Sun HW, Yan HF, Sun PM, Cui Y. Focus on management of gallstone ileus. Shijie Huaren Xiaohua Zazhi 2020; 28:1004-1008. [DOI: 10.11569/wcjd.v28.i20.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gallstone ileus is a rare form of intestinal obstruction and an uncommon complication of gallstone disease resulting from the impaction of one or more gallstones in the bowel owing to biliary intestinal fistula. The increasing incidence of gallstone ileus is related to the high prevalence of cholelithiasis, the aging of the population, and the more sensitive diagnostic tools. The diagnosis is often delayed due to the lack of typical clinical manifestations. In this paper, we discuss the pathogenesis of gallstone ileus, factors that result in its diagnosis, and therapeutic strategies by performing a systematic review of the literature. We also emphasize the specificity and complexity of gallstone ileus. We suggest that on the basis of observing the basic principles, the management should be rationalized and individualized in clinical practice so as to improve the prognosis of gallstone ileus.
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Affiliation(s)
- Hong-Wei Sun
- Department of General Surgery, Characteristic Medical Center of Chinese People's Liberation Army Strategic Support Force, Beijing 100101, China
| | - Hong-Feng Yan
- Department of General Surgery, Characteristic Medical Center of Chinese People's Liberation Army Strategic Support Force, Beijing 100101, China
| | - Pei-Ming Sun
- Department of General Surgery, Characteristic Medical Center of Chinese People's Liberation Army Strategic Support Force, Beijing 100101, China
| | - Yan Cui
- Department of General Surgery, Characteristic Medical Center of Chinese People's Liberation Army Strategic Support Force, Beijing 100101, China
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