Endoscopic and surgical treatment of jejunal gallstone ileus caused by cholecystoduodenal fistula:A case report  

作　　者：Wen-Juan Fan Mei Liu Xin-Xia Feng 

机构地区：[1]Department of Gastroenterology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei Province,China

出　　处：《World Journal of Clinical Cases》2023年第17期4159-4167,共9页世界临床病例杂志

基　　金：Supported by The National Natural Science Foundation of China,No.82100568.

摘　　要：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.

关 键 词：Gallstone ileus Cholecystoduodenal fistula PNEUMOBILIA Small bowel 

分 类 号：R657.4[医药卫生—外科学]