BACKGROUND Gallstone ileus is a rare complication of gallstone disease in which a stone enters the enteric lumen and causes mechanical obstruction usually by bilioenteric fistula.Gallstone ileus accounts for 25%of all...BACKGROUND Gallstone ileus is a rare complication of gallstone disease in which a stone enters the enteric lumen and causes mechanical obstruction usually by bilioenteric fistula.Gallstone ileus accounts for 25%of all bowel obstructions among the population>65 years of age.Despite medical advances over the last decades,gallstone ileus is still associated with high rates of morbidity and mortality.CASE SUMMARY An 89-year-old man with a history of gallstones was admitted to the Gastroenterology Department of our hospital,complaining of vomiting and cessation of bowel movements and flatus.Abdominal computed tomography showed cholecystoduodenal fistula and upper jejunum obstruction due to gallstones,pneumatosis in the gallbladder,and pneumobilia indicating Rigler’s triad.Considering the high risk of surgical management,we performed propulsive enteroscopy and laser lithotripsy twice to relieve the bowel occlusion.However,the intestinal obstruction was not relieved by the less invasive procedure.Then,the patient was transferred to the Department of Biliary-pancreatic Surgery.The patient underwent the one-stage procedure including laparoscopic duodenoplasty(fistula closure),cholecystectomy,enterolithotomy,and repair.After surgery,the patient presented with complications of acute renal failure,postoperative leak,acute diffuse peritonitis,septicopyemia,septic shock,and multiple organ failure,and finally died.CONCLUSION Early surgical intervention is the mainstay of treatment for gallstone ileus.For elderly patients with significant comorbidities,enterolithotomy alone is advised.展开更多
BACKGROUND Cholecystoenteric fistula(CEF)involves the formation of a spontaneous ano-malous tract between the gallbladder and the adjacent gastrointestinal tract.Chronic gallbladder inflammation can lead to tissue nec...BACKGROUND Cholecystoenteric fistula(CEF)involves the formation of a spontaneous ano-malous 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,pre-senting a challenge to the surgeon when detected intraoperatively.Therefore,a preoperative diagnosis of CEF is crucial.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 por-tion 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,colo-noscopy,and magnetic resonance cholangiopancreatography;the results of these tests con-firmed 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.展开更多
We report a case of a 92-year-old man complaining of epigastric pain, which an US first and a CT scan later revealed to be related to a large gallstone causing cholecystitis. After the patient had refused surgical tre...We report a case of a 92-year-old man complaining of epigastric pain, which an US first and a CT scan later revealed to be related to a large gallstone causing cholecystitis. After the patient had refused surgical treatment for this condition, he was again referred to our Emergency Department presenting with a clinical picture of gastric obstruction. A new CT scan showed the classic Rigler’s triad, characterized by pneumobilia, gastric distension and gallstone in the duodenal lumen, which was pathognomonic for a rare form of gallstone ileus named Bouveret’s syndrome. The cause of this event was found out to be the chronic inflammation of gallbladder wall and its consequent erosion, which led to formation of gallbladder-duodenum fistula and the movement of the gallstone from the gallbladder to the duodenum where it impacted. This is a high morbidity and mortality condition, which affects mostly elderly people and needs early diagnosis and surgical treatment.展开更多
An 85-year-old female patient visited our emergency department with a history of lower abdominal pain and vomiting. Abdominal plain CT showed small bowel obstruction caused by a gallstone measuring 3 cm in size in the...An 85-year-old female patient visited our emergency department with a history of lower abdominal pain and vomiting. Abdominal plain CT showed small bowel obstruction caused by a gallstone measuring 3 cm in size in the terminal ileum, gas in the gallbladder and adhesion in the gallbladder and duodenum. Thus, gallstone ileus with a cholecystoduodenal fistula was diagnosed. The gallstone was removed by the lower gastrointestinal endoscopy. Because of the high-risk status of the patient surgery, such as cholecystectomy or resection of the cholecystoduodenal fistula was not performed. Upper gastrointestinal endoscopy and radiography revealed the cholecystoduodenal fistula in the anterior wall of the duodenal bulb. Upper gastrointestinal radiography showed that the cholecystoduodenal fistula had been closed spontaneously without any complications on the 13th hospital day. Endoscopic removal of gallstone causing ileus is safe and effective as a less invasive alternative compared with surgery, although it requires condition that endoscope could reach the gallstone. The treatment method for the cholecystoduodenal fistula should be selected keeping in mind that conservative treatment, without surgery, may be effective.展开更多
基金Supported by The National Natural Science Foundation of China,No.82100568.
文摘BACKGROUND Gallstone ileus is a rare complication of gallstone disease in which a stone enters the enteric lumen and causes mechanical obstruction usually by bilioenteric fistula.Gallstone ileus accounts for 25%of all bowel obstructions among the population>65 years of age.Despite medical advances over the last decades,gallstone ileus is still associated with high rates of morbidity and mortality.CASE SUMMARY An 89-year-old man with a history of gallstones was admitted to the Gastroenterology Department of our hospital,complaining of vomiting and cessation of bowel movements and flatus.Abdominal computed tomography showed cholecystoduodenal fistula and upper jejunum obstruction due to gallstones,pneumatosis in the gallbladder,and pneumobilia indicating Rigler’s triad.Considering the high risk of surgical management,we performed propulsive enteroscopy and laser lithotripsy twice to relieve the bowel occlusion.However,the intestinal obstruction was not relieved by the less invasive procedure.Then,the patient was transferred to the Department of Biliary-pancreatic Surgery.The patient underwent the one-stage procedure including laparoscopic duodenoplasty(fistula closure),cholecystectomy,enterolithotomy,and repair.After surgery,the patient presented with complications of acute renal failure,postoperative leak,acute diffuse peritonitis,septicopyemia,septic shock,and multiple organ failure,and finally died.CONCLUSION Early surgical intervention is the mainstay of treatment for gallstone ileus.For elderly patients with significant comorbidities,enterolithotomy alone is advised.
文摘BACKGROUND Cholecystoenteric fistula(CEF)involves the formation of a spontaneous ano-malous 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,pre-senting a challenge to the surgeon when detected intraoperatively.Therefore,a preoperative diagnosis of CEF is crucial.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 por-tion 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,colo-noscopy,and magnetic resonance cholangiopancreatography;the results of these tests con-firmed 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.
文摘We report a case of a 92-year-old man complaining of epigastric pain, which an US first and a CT scan later revealed to be related to a large gallstone causing cholecystitis. After the patient had refused surgical treatment for this condition, he was again referred to our Emergency Department presenting with a clinical picture of gastric obstruction. A new CT scan showed the classic Rigler’s triad, characterized by pneumobilia, gastric distension and gallstone in the duodenal lumen, which was pathognomonic for a rare form of gallstone ileus named Bouveret’s syndrome. The cause of this event was found out to be the chronic inflammation of gallbladder wall and its consequent erosion, which led to formation of gallbladder-duodenum fistula and the movement of the gallstone from the gallbladder to the duodenum where it impacted. This is a high morbidity and mortality condition, which affects mostly elderly people and needs early diagnosis and surgical treatment.
文摘An 85-year-old female patient visited our emergency department with a history of lower abdominal pain and vomiting. Abdominal plain CT showed small bowel obstruction caused by a gallstone measuring 3 cm in size in the terminal ileum, gas in the gallbladder and adhesion in the gallbladder and duodenum. Thus, gallstone ileus with a cholecystoduodenal fistula was diagnosed. The gallstone was removed by the lower gastrointestinal endoscopy. Because of the high-risk status of the patient surgery, such as cholecystectomy or resection of the cholecystoduodenal fistula was not performed. Upper gastrointestinal endoscopy and radiography revealed the cholecystoduodenal fistula in the anterior wall of the duodenal bulb. Upper gastrointestinal radiography showed that the cholecystoduodenal fistula had been closed spontaneously without any complications on the 13th hospital day. Endoscopic removal of gallstone causing ileus is safe and effective as a less invasive alternative compared with surgery, although it requires condition that endoscope could reach the gallstone. The treatment method for the cholecystoduodenal fistula should be selected keeping in mind that conservative treatment, without surgery, may be effective.
