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.

中文翻译：

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像滚动的（胆）石：乙状结肠胆结石梗阻的最佳治疗

摘要

背景

乙状结肠胆石性肠梗阻是胆石症的一种罕见并发症，占所有大肠梗阻病例的 1-4%。由于其诊断具有挑战性且发病较晚，这是一种高度病态且常常致命的疾病。

案例展示

我们报告一例因胆囊结肠瘘导致近端乙状结肠憩室中 6 厘米的胆结石滞留在急诊室的 90 岁女性，因腹痛和大肠梗阻而被送入急诊室。由于胆结石尺寸很大，结肠镜检查失败的可能性很高，因此推迟了结肠镜检查。该患者接受了紧急剖腹手术，并通过结肠切开术取出胆结石。胆囊结肠瘘未得到治疗。术后过程很顺利; 患者于术后第6天出院。

结论

通常需要内窥镜医师和外科医生之间的多学科讨论来选择最佳的治疗方案，特别是对于高危患者。