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Louis M, Grabill N, Kuhn B, Gibson B. What are the clues to gallstone ileus when stones don't show up on scans? A case presentation and literature review. Radiol Case Rep 2024; 19:5018-5023. [PMID: 39247463 PMCID: PMC11378721 DOI: 10.1016/j.radcr.2024.07.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 09/10/2024] Open
Abstract
Gallstone ileus is a rare yet significant cause of mechanical bowel obstruction, particularly in elderly patients. This condition arises when gallstones migrate into the gastrointestinal tract through a cholecystoenteric fistula, often due to chronic inflammation. Despite medical advancements, gallstone ileus remains associated with high morbidity and mortality rates due to delayed diagnosis and nonspecific symptoms. The clinical presentation typically includes intermittent nausea, vomiting, abdominal pain, and constipation, which can obscure the diagnosis. Advanced imaging techniques, especially computed tomography (CT), are crucial for identifying key diagnostic features such as pneumobilia, ectopic gallstones, and signs of bowel obstruction. Gallstone ileus should be considered in any case of small bowel obstruction, even if CT imaging is inconclusive, as gallstones can be radiolucent. Indirect clues like pneumobilia and dilated small bowel loops can lead to the diagnosis. Effective management of gallstone ileus requires prompt surgical intervention to remove the obstructing gallstone and restore bowel patency. The primary surgical procedure is enterolithotomy, although additional procedures such as cholecystectomy and fistula repair may be necessary depending on the patient's condition and intraoperative findings. The choice of surgical approach should be individualized, considering the patient's overall health and the specific characteristics of the obstruction. Early recognition and timely surgical management are essential to prevent complications and improve patient outcomes.
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Affiliation(s)
- Mena Louis
- Northeast Georgia Medical Center, General Surgery Department. Gainesville, GA 30501, USA
| | - Nathaniel Grabill
- Northeast Georgia Medical Center, General Surgery Department. Gainesville, GA 30501, USA
| | - Bradley Kuhn
- Northeast Georgia Medical Center, Trauma and Acute Care Surgery Department. Gainesville, GA 30501, USA
| | - Brian Gibson
- Northeast Georgia Medical Center, Trauma and Acute Care Surgery Department. Gainesville, GA 30501, USA
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Zhang Q, Meng H, Chen Y, Meng F. Bezoar as a cause of portal vein pneumatosis: a case report. J Int Med Res 2023; 51:3000605231180540. [PMID: 37377054 DOI: 10.1177/03000605231180540] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
Pneumatosis of the portal vein is considered a rare imaging sign rather than a disease. It usually occurs in patients with digestive tract diseases such as intestinal obstructive diseases, mesenteric vascular diseases, closed abdominal trauma, and liver transplantation. Because of its high mortality rate, it is also termed the "sign of death." Hawthorn contains tannic acid, and seafood is rich in calcium, iron, carbon, iodine, and other minerals and proteins. Thus, consuming both hawthorn and seafood together can result in the formation of an indigestible complex in the body, acting as the main pathogenic factor in patients with intestinal obstruction. We herein describe a patient with duodenal obstruction caused by hawthorn who developed the hepatic portal venous gas sign and was cured by nonsurgical treatment.
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Affiliation(s)
- Qing Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
| | - Heyu Meng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
| | - Yanqiu Chen
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
| | - Fanbo Meng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
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Rojo Ríos D, Ramírez Zarzosa G, Soler Laguía M, Kilroy D, Martínez Gomariz F, Sánchez Collado C, Gil Cano F, García García MI, Jáber JR, Arencibia Espinosa A. Creation of Three-Dimensional Anatomical Vascular and Biliary Models for the Study of the Feline Liver ( Felis silvestris catus L.): A Comparative CT, Volume Rendering (Vr), Cast and 3D Printing Study. Animals (Basel) 2023; 13:ani13101573. [PMID: 37238006 DOI: 10.3390/ani13101573] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
In this study, six adult feline cadavers were examined using CTA, 3D printing, and casts injected with epoxy. The aorta, the portal vein, and the gallbladder of 3 feline cadavers were separately injected with a 50% mixture of colored vulcanized latex and hydrated barium sulfate as contrast medium to analyze by CT the arterial, venous and biliary systems. The other three cadavers were injected with a mixture of epoxy resin in the aorta, gallbladder and hepatic veins, separately. After the corrosion and washing process, hepatic vascular and biliary casts were obtained. The images obtained by CT showed the vascular and biliary system using a soft tissue window. For the identification of vascular and biliary structures, the 3D prints together with the 3D reconstructions were analyzed, and the results were compared with the casts obtained with epoxy resin. Each of the arterial, venous and biliary branches associated with each of the liver lobes were identified with the help of the printings. In conclusion, the creation of 3D prototypes of nonpathological feline hepatic parenchyma can be used in the veterinary clinic as a basis for the detection of pathological problems in addition to obtaining future pathological hepatic 3D models.
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Affiliation(s)
- Daniel Rojo Ríos
- Department of Anatomy and Comparative Pathological Anatomy, Veterinary Faculty, Campus de Espinardo, University of Murcia, 30100 Murcia, Spain
| | - Gregorio Ramírez Zarzosa
- Department of Anatomy and Comparative Pathological Anatomy, Veterinary Faculty, Campus de Espinardo, University of Murcia, 30100 Murcia, Spain
| | - Marta Soler Laguía
- Department of Animal Medicine and Surgery, Veterinary Faculty, Campus de Espinardo, University of Murcia, 30100 Murcia, Spain
| | - David Kilroy
- Veterinary Science Centre, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Francisco Martínez Gomariz
- Department of Anatomy and Comparative Pathological Anatomy, Veterinary Faculty, Campus de Espinardo, University of Murcia, 30100 Murcia, Spain
| | - Cayetano Sánchez Collado
- Department of Anatomy and Comparative Pathological Anatomy, Veterinary Faculty, Campus de Espinardo, University of Murcia, 30100 Murcia, Spain
| | - Francisco Gil Cano
- Department of Anatomy and Comparative Pathological Anatomy, Veterinary Faculty, Campus de Espinardo, University of Murcia, 30100 Murcia, Spain
| | | | - José Raduán Jáber
- Department of Morphology, Veterinary Faculty, University of Las Palmas de Gran Canaria, 35413 Las Palmas, Spain
| | - Alberto Arencibia Espinosa
- Department of Morphology, Veterinary Faculty, University of Las Palmas de Gran Canaria, 35413 Las Palmas, Spain
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Cordella A, Gianesini G, Zoia A, Ventura L, Bertolini G. Multi-phase MULTIDETECTOR-row computed tomographic features and laboratory findings in dogs with gallbladder rupture. Res Vet Sci 2022; 153:137-143. [PMID: 36368275 DOI: 10.1016/j.rvsc.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 09/02/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Gallbladder rupture is a life-treating condition in dogs. In human medicine, multidetector-row computed tomography (MDCT) is considered the best modality for the diagnosis of gallbladder rupture. The aims of the study were to describe MDCT features of gallbladder rupture in dogs and to determine the CT findings and laboratory data that differ between dogs with ruptured biliary tree and dogs with biliary disease with no rupture. For this single-center, cross-sectional study were considered for inclusion dogs presented from May 2010 to September 2020, with surgical diagnosis of gallbladder rupture or integrity, who underwent MDCT examination and with CBC and biochemistry results available for review. Forty-seven dogs with different diseases of the biliary tract were included. Seventeen dogs with confirmed gallbladder rupture and 30 dogs with intact gallbladder were included. Multiple MDCT findings showed statistical significance in distinguish dogs with gallbladder rupture: irregular contours of the gallbladder (p < 0.0001), discontinuation of the gallbladder wall (p = 0.0005), adhesions with adjacent organs (p = 0.005), heterogeneous enhancement of the gallbladder wall (p = 0.01), pericholecystic effusion (p = 0.001) and pericholecystic peritonitis (p = 0.001). The presence of three or more of these findings was highly indicative for gallbladder rupture (AUC = 0.921). In this study, MDCT proved to be useful in differentiating dogs with gallbladder rupture from dogs with biliary disease without rupture.
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Affiliation(s)
- Alessia Cordella
- Diagnostic and Interventional Radiology Division of San Marco Veterinary Clinic and Laboratory, Veggiano (Padova), Italy
| | - Giulia Gianesini
- Internal Medicine Division of San Marco Veterinary Clinic and Laboratory, Veggiano (Padova), Italy
| | - Andrea Zoia
- Internal Medicine Division of San Marco Veterinary Clinic and Laboratory, Veggiano (Padova), Italy
| | - Laura Ventura
- Department of Statistical Sciences, University of Padova, Via Battisti, 241 -, 35121 Padova, (Italy)
| | - Giovanna Bertolini
- Diagnostic and Interventional Radiology Division of San Marco Veterinary Clinic and Laboratory, Veggiano (Padova), Italy.
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