A single centre case series of gallstone sigmoid ileus management
نویسندگان
چکیده
AIMS/INTRODUCTION Gallstone sigmoid ileus is a rare condition that presents with symptoms of large bowel obstruction secondary to a gallstone impacted within the sigmoid colon. This arises because of three primary factors: cholelithiasis causing a cholecystoenteric fistula; a gallstone large enough to obstruct the bowel lumen; and narrowing of the bowel. We describe 3 patients treated in a district general hospital over a 3-year period, and discuss their management. METHODS Cases were retrospectively analysed from a single center between 2015 and 2017 in line with the SCARE guidelines. RESULTS 3 patients - 2 female, 1 male. Age: 89, 68, 69 years. 2 cholecystocolonic fistulae, 1 cholecystoenteric (small bowel) fistula. Patient 1: Unsuccessful endoscopic attempts to retrieve the (5×5cm) gallstone resulted in surgery. Retrograde milking of the stone to caecum enabled removal via modified appendicectomy. Patient 2: Endoscopy and lithotripsy failed to fragment stone. Prior to laparotomy the stone was palpated in the proximal rectum enabling manual extraction. Patient 3: Laparotomy for gallstone ileus failed to identify a stone within the small bowel. Gallstone sigmoid ileus then developed. Conservative measures successfully decompressed the large bowel 6days post-operation. CONCLUSIONS This is the first case series highlighting the differing strategies and challenges faced by clinicians managing gallstone sigmoid ileus. Conservative measures (including manual evacuation), endoscopy, lithotripsy and surgery all play important roles in relieving large bowel obstruction. It is essential to tailor care to individual patients' needs given the complexities of this potentially life threatening condition.
منابع مشابه
Sigmoid gallstone ileus: a rare cause of large bowel obstruction.
DESCRIPTION A91-year-oldwoman presentedwith abdominal distension and pain. She had not vomited and opened her bowels only with scanty stool. On examination she was tachycardic with a distended abdomen with left-sided tenderness. On admission her C reactive protein was 77 mg/l, white cell count of 9.9×10l and normal liver function tests. Abdominal plain films revealed dilated large bowel. Subseq...
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Colonic gallstone ileus in an uncommon mechanical bowel obstruction caused by intraluminal impaction of one or more gallstones. The surgical management of gallstone ileus is complex and is potentially of high risk. There have been reports of gallstone extractions using various endoscopic modalities to relieve the obstruction. In this report we present the technique employed to successfully perf...
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Gallstone ileus is an uncommon cause of intestinal obstruction and occurs following the formation of a cholecystoenteric fistula, permitting passage of gallstones into the gastrointestinal tract. Impaction of a gallstone in the sigmoid colon is rare and is usually at sites of previous colonic disease. Definitive management can be challenging due to the advanced age and co-morbidity usually seen...
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BACKGROUND A gallstone colonic ileus is a very rare condition. CLINICAL CASE The case is reported of an 87 year-old patient who came to the Emergency Department due to an intestinal obstruction of several days onset, which was caused by a gallstone affected sigmoid colon. CONCLUSION Colonic gallstone ileus is a rare disease that usually occurs in older patients due to the passage of large g...
متن کاملA systematic review of gallstone sigmoid ileus management
Introduction Gallstone sigmoid ileus is a rare although serious complication of cholelithiasis resulting in large bowel obstruction. The condition accounts for 4% of all gallstone ileus patients. There are no recognized management guidelines currently. Management strategies range from minimally invasive endoscopy and lithotripsy to substantial surgery. We aim to identify trends when managing pa...
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