Diagnosis Of Gallstone Ileus Research Articles

Gallstone ileus

A 73-year-old woman presented with 5-day history of colicky abdominal pain, distension, vomiting, and signs of peritonism in the lower abdomen. She had no history of biliary pain. An abdominal radiograph showed dilated loops of small bowel, air in the biliary tree and gall bladder (figure, thick arrows), and a peripherally radioopaque stone in the bowel (figure, thin arrow). We agreed on a preoperative diagnosis of gallstone ileus. At surgery the 3·5 cm solitaire gallstone was found in the distal jejunum with two 5 mm perforations close to the site of impaction. These perforations were probably at the sites of two previous impactions. The closest perforation was at the mesenteric border and required resection of a small segment of jejunum. There were dense adhesions around the gall bladder, but these were left alone. Apart from a slight wound infection, the patient made an uneventful postoperative recovery. A 73-year-old woman presented with 5-day history of colicky abdominal pain, distension, vomiting, and signs of peritonism in the lower abdomen. She had no history of biliary pain. An abdominal radiograph showed dilated loops of small bowel, air in the biliary tree and gall bladder (figure, thick arrows), and a peripherally radioopaque stone in the bowel (figure, thin arrow). We agreed on a preoperative diagnosis of gallstone ileus. At surgery the 3·5 cm solitaire gallstone was found in the distal jejunum with two 5 mm perforations close to the site of impaction. These perforations were probably at the sites of two previous impactions. The closest perforation was at the mesenteric border and required resection of a small segment of jejunum. There were dense adhesions around the gall bladder, but these were left alone. Apart from a slight wound infection, the patient made an uneventful postoperative recovery.

Gallstone Ileus

Gallstone ileus is a mechanical obstruction of the intestinal tract caused by gallstones. Usually, the responsible stone is solitary and large, 2 to 5 cm in diameter, and enters the bowel through a cholecystoduodenal fistula. Gallstone ileus is not a common occurrence. This condition can be difficult to diagnose, causing a delay in surgical treatment. Because of this delay, the mortality rate is high, 15% to 20%. When the diagnosis of gallstone ileus is made preoperatively, it is usually done radiographically. In this case, the diagnosis was made based on the ultrasound findings.

Gallstone ileus: increased diagnostic sensitivity by combining plain film and ultrasound.

Gallstone ileus is an uncommon cause of mechanical obstruction. Its high mortality rate can be reduced with earlier diagnosis and treatment. We wanted to determine whether ultrasound (US) performed after plain film increases the sensitivity for the preoperative diagnosis. We performed a 5-year retrospective analysis of radiologic and sonographic results of 23 patients who had surgery because of gallstone ileus. Rigler's triad was identified by plain abdominal film in two patients (9%) and by US in 16 patients (69%). Plain abdominal film contributed to a definitive diagnosis in four cases and to a probable diagnosis in six cases (sensitivities of 17% for definitive diagnoses and 43% for definitive and probable diagnoses). US confirmed the diagnosis in six cases of probable gallstone ileus and provided the diagnosis in seven of 13 patients without suspected gallstone ileus based on plain abdominal film. The best results were obtained by combining plain film and US findings, with sensitivities of 74% for definitive diagnoses and 96% for definitive plus probable diagnoses. The preoperative diagnosis of gallstone ileus significantly increases by combining plain film and US findings.

Ultrasonography in the diagnosis of gallstone ileus: Report of a case

Gallstone ileus is an uncommon mechanical bowel obstruction caused by impaction of one or more gallstones in the intestine. The ileum is involved in about 80% of cases. Difficult and delayed diagnosis and old age of the patients account for its high mortality. We herein report one case with gallstone ileus diagnosed by ultrasound preoperatively in which the patient survived after surgery with only a few complications related to the patient's debilitated medical problems. Emphasis is also put upon how to deal with acute abdomen in elderly patients; in addition to traditional roentgenography, ultrasound may afford a tool to detect gallstone ileus.

A CASE OF GALLSTONE ILEUS AND REVIEW OF CUMULATED 130 CASES IN THE JAPANESE LITERATURE

Gallstone ileus is a rare complication of cholelithiasis, which has been supposed to be difficult to diagnose preoperatively. This paper describes a case of gallstone ileus successfully diagnosed preoperatively, with a review of 130 cases in the Japanese literature for the last 11 years. A 79-year-old woman was hespitalized into the hospital because of abdominal pain. Abdominal simple X-ray films revealed that an oval-shaped calcificated gallstone passed into the upper intestine, and several days later, it packed into the ileum and caused obstruction of the ileum. Laparotomy was performed under a diagnosis of gallstone ileus 24 days after admission. The impacted stone (5×3cm) was removed through enterotomy and no biliary radical operation was carried out. It is known that this disease has been first diagnosed at laparotomy in most cases with a high operative mortality. Cumulated 130 cases reported in the Japanese literature since 1980, however, has indicated that the preoperative correct diagnosing rate is increasing and operative deaths are decreasing.

Case Report: Ultrasound in the diagnosis of gallstone ileus

Recent case reports have shown that ultrasound can be useful in the diagnosis of gallstone ileus. A further patient is presented in whom the ultrasonic demonstration of dilated bowel loops, air in the gall-bladder, and an ectopic gallstone clinched the diagnosis when the plain radiographs demonstrated only small bowel obstruction. A pitfall in the ultrasound diagnosis is also discussed.

Gallstone ileus masquerading as recurrent carcinoma of the ovary

A case of gallstone ileus in a patient with carcinoma of the ovary is presented. A 78-year-old female with stage III carcinoma of the ovary underwent optimal debulking surgery followed by six courses of chemotherapy and a microscopically positive second-look laparotomy. She was treated by whole-abdomen pelvic radiation. She then developed progressive nausea, vomiting, abdominal distension, and eventually complete small bowel obstruction. The diagnosis of gallstone ileus was made preoperatively based on the radiological findings. The pathophysiology of gallstone ileus is discussed in the differential diagnosis of patients treated for carcinoma of the ovary.

A CASE OF PREOPERATIVELY DIAGNOSED GALLSTONE ILEUS

Gallstone ileus is a relatively rare complication of cholelithiasis and it is hardly diagnosed preoperatively. This paper describes a such case in which we could successfully diagnosed preoperatively, together with a review of about 200 cases in the Japanese literature. A 66-year-old male was admitted because of a half-day history of abdominal pain with nausea on June 6, 1988. He had moderate leukocytosis and his abdomen was slightly distended with mild tenderness at the epigastrium. Abdominal plain X-ray films revealed a small bowel obstruction, air in the gallbladder and a oval-shaped calcificated mass of which position was changed daily on it. The upper G-I series showed a cholecystoduodenal fistula and an impacted gallstone in the terminal ileum. Laparotomy was carried out under a diagnosis of gallstone ileus 7 days after the admission. The impacted stone, measured 5×3×3cm, was milked back from the terminal ileum and was removed through enterotomy. Cholecystectomy and closure of the cholecystoduodenal fistula were performed. Postoperative course was uneventfull.

超音波検査が術前診断に有用であった胆石イレウスの１例

超音波検査が術前診断に有用であった胆石イレウスの１例

A CASE OF GALLSTONE ILEUS WITH COMPLETE FOLLOW-UP OF THE CLINICAL COURSE FROM INTRAGASTRIC EXCRETION OF THE INTACYSTIC STONE TO ONSET

Gallstone ileus is a relatively rare complication of cholelithiasis. This paper reports a peculiar case of gallstone ileus in which a gallstone entering the stomach through an internal biliary fistula was well recognized by chance upon X-ray films in an upper GI series.A 55-year-old woman presented with dull obdominal pain. She underwent various examinations in an outpatient department and a gallstone was revealed by ultrasonography. Subsequent X-ray studies of the upper GI tract demonstrated a transparent shadow approximately 25 mm in diameter in the stomach. The shadow was considered to correspond to a gallstone which had passed into the stomach. Symptoms due to ileus appeared thereafter, and on admission laparotomy was performed under a diagnosis of gallstone ileus. A gallstone the size of a small hen's egg was found impacted in the small bowel about 100 cm orad from the terminal ileum. The stone was removed via an intestinal transverse incision and then suitable surgical treatments for the biliary and upper GI tracts were added. Postoperative course was uneventful. Paradoxically, in this case, it is considered that premedication for an upper GI series (intramuscular injection of Coliopan and atropine sulfate) could have acted to some extent in inducing the expulsion of the gallstone through a cholecystoprepyloric fistula.

A CASE OF GALLSTONE ILEUS

An obese 79-year-old diabetic woman was admitted with a history of intermittent abdominal pain and vomitting. Two years previously, she had been investigated in our hospital for cholecystolithiasis. Plain radiographs of abdomen with the patient supine revelaed air in the biliary tree and incomplete small-bowel obstruction. With the pre-operative diagnosis of gallstone ileus, laparotomy was performed, and 2.5cm calculus was removed from the jejunum. A large cholecysto-duodenal fistula was noted, but no further surgery was performed on account of high risk. Recovery was satisfactory and free from complications. We analyzed 160 cases of gallstone ileus in Japan with special reference to treatment. We classified gallstone ileus into four types, according to the number, position of the stones before they enter the bowels. In type 1, there was no difference in the incidence of complications between the ileus operation group and the ileus operation plus radical operation group. In types 2 and 3, the incidence of complications was significantly lower in the ileus operation plus radical operation group than in the ileus operaton group. These results suggested that surgical removal of gallstones that obstruct the intestine will have good results in type 1 patients, but that additional radical surgery should be undertaken primarily or secondarily in type 2 or 3 patients with gallstone ileus.

Barium enema in diagnosis of gallstone ileus.

To the Editor. —We are writing to describe a case in which gallstone obstruction of the distal part of the ileum was diagnosed preoperatively by barium contrast examination of the colon. Report of a Case A 75-year-old white man had a four-day history of intermittent symptoms suggestive of the tumbling or migrating phenomenon of intermittent obstruction occurring at more caudal areas in the small intestine, as a result of a stone being pushed distally by peristaltic action. The admission roentgenographic diagnosis was small intestinal obstruction. Barium enema examination was performed (Figure), and the barium column refluxed past the ileocecal valve into the terminal part of the ileum, and around an obstructing intraluminal mass (gallstone). Although the intraluminal mass may have represented a tumor, the clinical course suggested a gallstone. At surgery, an obstructing, 3 × 2.3 × 2.0-cm, intraluminal stone was identified and removed. Comment There is frequent difficulty in

Gas in the portal vein. A report of two cases.

The presence of gas in the portal vein is infrequently recognised during life, and is of grave prognostic significance. Nine cases have so far been reported in adult life, and only two of these, described by Barrett (1962) are in the British literature. The remaining seven cases are recorded in the North American literature. Seven cases have been described in infancy; six by Wolfe and Evans (1955) and a further case by Wiot and Felson (1961). We wish to record two further cases in adults, one following mesenteric embolus, and the other due to mesenteric artery thrombosis. Mrs. R. G., 54 years, was seen on a domiciliary visit when congestive heart failure was observed and a diagnosis of cardiomyopathy made. There had been no chest pain. She was admitted to hospital ten days later with vomiting and diarrhoea but no pain. Gastroenteritis was diagnosed. Her general condition was good at admission but four hours afterwards she suffered severe abdominal pain and became shocked. A plain X-ray film of the abdomen showed gas within the liver shadow (Fig. 1a). A diagnosis of gall-stone ileus was made. Laparotomy (Mr. C. Q. Henriques) revealed extensive gangrene of the small bowel thought to be due to mesenteric artery thrombosis. She died shortly after operation. Post-mortem examination showed gangrene of almost the whole of the small intestine, and of the ascending colon, due to superior mesenteric artery embolism.

The Clinical Significance of Air and Barium in the Biliary Tract

The presence of air or barium in the biliary tract indicates either an internal biliary fistula or regurgitation through an incompetent sphincter of Oddi. The finding of air in the biliary tract assumes special significance in the presence of small-bowel obstruction. In such a case the diagnosis of gallstone ileus is very strongly suggested, even though no calculus is visible. Within the past year we have seen six patients who had either air or barium in the biliary tract. One patient had a cholecytocolic fistula, one had a cholecystoduodenal fistula; in one patient there was regurgitation through an incompetent sphincter of Oddi secondary to a chronic pancreatitis, in two cases the cause was not determined anatomically, and in one patient a cholecystojejunostomy had been performed one year previously for carcinoma of the ampulla of Vater. Incidence, Etiology, and Significance Spontaneous internal biliary fistulas are among the least common complications of

The roentgen diagnosis of gallstone ileus.

There are many communications in the literature describing gallstone or biliary ileus. In the period 1941 to 1950 88 papers on this subject were published. The majority of these are isolated case reports and few deal solely with the. radiographic diagnosis. Two factors serve to re-alert roentgenologists to an understanding and diagnosis of gallstone ileus. One is the high mortality of the disease; the other is the number of reports of gallstone obstruction from the surgical point of view which fail to mention the roentgen findings. As recently as 1950 a report (1) of 7 cases in which gallstone ileus was found at operation stated that “the roentgenographic examination appears to be of little value.” None of these cases were diagnosed before surgery. Denneen and Broderick (2) reported 1 case in a series of 10 which was recognized preoperatively. The present paper is based upon 8 cases in which the diagnosis was made or suggested prior to surgery or death. Four of these will be reported in some detail. In the opinion of the author, in the great majority of patients with this disease a diagnosis can easily be made. Early diagnosis is essential, since there is a notoriously long delay between the onset of symptoms and operation. The advanced age of most of the patients and concurrent cardiovascular-renal disease are additional reasons for the 50 per cent mortality which is the mean for this condition. In 1941, Rigler and his associates (3) reported 14 cases of gallstone ileus and discussed the diagnostic signs. The tenth published case of recurrent gallstone ileus was contributed by Noskin and Tannenbaum (4) in 1952. Lomhoff and Dubowy (5) reported a case of gallstone ileus associated with diverticulitis of the colon. The discovery of an obstructing calculus in the sigmoid, with the sigmoidoscope, was described by d'Abreu (6). Mayo and Brown (7), in 1949, reported the surgical aspects of 18 cases. Five diagnoses3 of mechanical ileus caused by an impacted gallstone were made at the Evanston Hospital from 1940 through 1951; this number represented 2.5 per cent of the 229 mechanical bowel obstructions in patients over eighteen years of age seen during that interval. This figure is in close agreement with those of Frimann-Dahl (8), 2 per cent, and of Rigler et al., 0.4 to 5.0 per cent. Recently Nemir (9) reported 8 cases of gallstone ileus treated surgically, representing 1.4 per cent of 549 cases of mechanical intestinal obstructions of all kinds. Erosion through the wall of the gallbladder into the alimentary canal is the common path by which a biliary calculus may gain entrance to the gut. A fistula is necessarily formed, usually cholecystoduodenal or cholecystojejunal. Rigler reported a choledochoduodenal fistula derived from the passage of a stone through the wall of the distal common duct into the duodenum. Many authors doubt if gallstones ever reach the intestine via natural channels.

The Roentgenologic Diagnosis of Gallstone Ileus, Specially as Regards the Demonstration of Obstructing Radiotransparent Concrements

The Roentgenologic Diagnosis of Gallstone Ileus, Specially as Regards the Demonstration of Obstructing Radiotransparent Concrements

The Roentgenologic Diagnosis of Gallstone Ileus, Specially as Regards the Demonstration of Obstructing Radiotransparent Concrements

The Roentgenologic Diagnosis of Gallstone Ileus, Specially as Regards the Demonstration of Obstructing Radiotransparent Concrements