Sonographische Diagnose einer biliodigestiven Fistel mit Gallensteinileus

Rauh, Peter; Neye, Holger; Ensberg, Daniel; Bönicke, P; Georgiew, E; Rickes, Steffen

doi:10.1055/s-0029-1244849

Cited by 2 publications

(3 citation statements)

References 6 publications

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“…The cause of obstruction often remains undetermined on abdominal radiograms, and the full triad is found in only 14%–53% of cases [6,13,14,15]. Other imaging options such as CT scans and ultrasound perform better [13,16,17,18]. The use of ultrasound enables the detection not only of the impacted stone, but also the site of the fistula and the presence of cholelithiasis [17].…”

Section: Discussionmentioning

confidence: 99%

“…Other imaging options such as CT scans and ultrasound perform better [13,16,17,18]. The use of ultrasound enables the detection not only of the impacted stone, but also the site of the fistula and the presence of cholelithiasis [17]. Ultrasound is highly operator-dependent and the technical difficulties when performing an ultrasound on a patient with bowel obstruction (discomfort, bowel full of gas/fluid) make it difficult to use as the main modality in the acute abdomen setting [16].…”

Section: Discussionmentioning

confidence: 99%

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Gallstone Ileus: Management and Clinical Outcomes

et al. 2019

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Background: Gallstone or biliary ileus is a late complication of gallstone disease. It accounts for 1%–4% of all bowel obstructions and is more common in elderly patients. The preferred treatment option is to mechanically remove the impacted stones. It is done surgically using open or laparoscopic approach and rarely, when stones are impacted in the colon, endoscopically. In this paper we present five consecutive cases of gallstone ileus and describe possible diagnostic and minimally invasive treatment options. Case presentation: During a five-month period a total of five patients were treated for gallstone ileus. All patients were female and from 48 to 87 years of age. Symptoms were not specific and common for all small bowel obstructions. Upon admission the patients also had unspecific laboratory findings—neutrophilic leukocytosis and various C-reactive protein concentrations, ranging from 8 to 347 mg/L. According to the hospital protocol, all patients initially underwent an abdominal ultrasound, which was inconclusive, and therefore every patient additionally had a CT scan with intravenous contrast. After these two diagnostic modalities one patient still did not have the definitive gallstone ileus diagnosis, as the ectopic stone was not visible. Four patients in our case series were treated using minimally invasive methods: in one case the stone was removed endoscopically, and laparoscopically in the other three. Treatment outcomes were good in four cases as the patients fully recovered, however one patient suffered a massive cerebral infarction after the operation and passed away. Conclusions: Gallstone ileus is a rare and difficult-to-diagnose condition. Management of these patients in every case should be individualized, as there are many options, each with their own advantages and disadvantages. We show that minimally invasive treatment such as colonoscopy or laparoscopy is possible in these cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gallstone Ileus: Management and Clinical Outcomes

et al. 2019

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“…The diagnosis was made on the basis of the results of an abdominal CT scan and gastroscopy. However, a biliary enteral fistula and a gallstone ileus may also be seen by ultrasound imaging [10]. The therapeutic approach to our patient having gallstone ileus remains a subject of debate, mostly due to a lack of large prospective studies.…”

Section: Discussionmentioning

confidence: 99%

Development of a duodenal gallstone ileus with gastric outlet obstruction (Bouveret syndrome) four months after successful treatment of symptomatic gallstone disease with cholecystitis and cholangitis: a case report

et al. 2010

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IntroductionCases of gallstone ileus account for 1% to 4% of all instances of mechanical bowel obstruction. The majority of obstructing gallstones are located in the terminal ileum. Less than 10% of impacted gallstones are located in the duodenum. A gastric outlet obstruction secondary to a gallstone ileus is known as Bouveret syndrome. Gallstones usually enter the bowel through a biliary enteral fistula. Little is known about the formation of such fistulae in the course of gallstone disease.Case presentationWe report the case of a 72-year-old Caucasian woman born in Germany with a gastric outlet obstruction due to a gallstone ileus (Bouveret syndrome), with a large gallstone impacted in the third part of the duodenum. Diagnostic investigations of our patient included plain abdominal films, gastroscopy and abdominal computed tomography, which showed a biliary enteric fistula between the gallbladder and the duodenal bulb. Our patient was successfully treated by laparotomy, duodenotomy, extraction of the stone, cholecystectomy, and resection of the fistula in a one-stage surgical approach. Histopathological examination showed chronic and acute cholecystitis, with perforated ulceration of the duodenal wall and acute purulent inflammation of the surrounding fatty tissue. Four months prior to developing a gallstone ileus our patient had been hospitalized for cholecystitis, a large gallstone in the gallbladder, cholangitis and a small obstructing gallstone in the common biliary duct. She had been treated with endoscopic retrograde cholangiopancreatography, endoscopic biliary sphincterotomy, balloon extraction of the common biliary duct gallstone, and intravenous antibiotics. At the time of her first presentation, abdominal ultrasound and endoscopic examination (including esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography) had not shown any evidence of a biliary enteral fistula. In the four months preceding the gallstone ileus our patient had been asymptomatic.ConclusionIn patients known to have gallstone disease presenting with symptoms of ileus, the differential diagnosis of a gallstone ileus should be considered even in the absence of preceding symptoms related to the gallbladder disease. Gallstones large enough to cause intestinal obstruction usually enter the bowel by a biliary enteral fistula. During the formation of such a fistula, patients can be asymptomatic.

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Sonographische Diagnose einer biliodigestiven Fistel mit Gallensteinileus

Abstract: This case report demonstrates that percutaneous ultrasonography should be used as the first imaging procedure in the diagnosis of acute abdominal pain. This procedure makes it possible to detect a gallstone ileus. It is important also to define various intestinal structures accurately.

Cited by 2 publications

References 6 publications

Gallstone Ileus: Management and Clinical Outcomes

Gallstone Ileus: Management and Clinical Outcomes

Development of a duodenal gallstone ileus with gastric outlet obstruction (Bouveret syndrome) four months after successful treatment of symptomatic gallstone disease with cholecystitis and cholangitis: a case report

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