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Zabeirou A, Saidou A, Younssa H, James Didier L, Younoussa M, Sani R. An authentic radiological triad of Rigler allowing the diagnosis of gallstone ileus: A case report. Radiol Case Rep 2024; 19:1565-1567. [PMID: 38317700 PMCID: PMC10839758 DOI: 10.1016/j.radcr.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
The Rigler's Triad consists by three radiological signs, including intestinal obstruction, pneumobilia, and an aberrant gallstone in the bowel. It is an inconstant triad considered being pathognomonic of gallstone ileus. Gallstone ileus is an exceptional complication of cholelithiasis due to the passage of one or more gallstones from the bile ducts into the lumen of the bowel through a biliodigestive fistula. We report the case of an 83-year-old female patient with a history of ischemic heart disease and an asymptomatic large gallstone. The patient was admitted to the emergency department for bowel obstruction, abdominal pain, and bilious vomiting. A clinical examination found a patient with an alteration in general condition and a distended abdomen with tenderness. An abdominal CT scan revealed Rigler's triad, allowing the diagnosis of gallstone ileus. A midline exploratory laparotomy was performed to find a giant gallstone blocked in the last ileum loop. A simple enterolithotomy was performed, allowing the extraction of giant lithiasis from an 8-cm major axis. The postoperative evolution was uneventful, and the patient was discharged 4 days after surgical treatment.
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Affiliation(s)
- Aliou Zabeirou
- Department of General and Visceral Surgery, General Hospital of References of Niamey, Niamey, Niger
| | - Adama Saidou
- Faculty of Health sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Hama Younssa
- Faculty of Health sciences, Abdou Moumouni University of Niamey, Niamey, Niger
| | - Lassey James Didier
- Department of General and Visceral Surgery, General Hospital of References of Niamey, Niamey, Niger
| | - Moussa Younoussa
- Department of General and Visceral Surgery, General Hospital of References of Niamey, Niamey, Niger
| | - Rachid Sani
- Faculty of Health sciences, Abdou Moumouni University of Niamey, Niamey, Niger
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Kim SH, Jeong MJ, Kim JY, Lee JH, Kang MJ. Sphincter of Oddi incompetence associated with duodenal stenosis in a newborn: A case report. Radiol Case Rep 2023; 18:3256-3259. [PMID: 37483378 PMCID: PMC10359933 DOI: 10.1016/j.radcr.2023.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Newborn incompetence of the sphincter of Oddi is rare. While there are many causes of reflux of air or ingested contrast material into the biliary tree in adults, in the newborn, it is usually due to incompetence of the sphincter of Oddi associated with partial or complete duodenal obstruction. This paper presents upper gastrointestinal series findings of incompetence of the sphincter of Oddi associated with duodenal stenosis in a 3-day-old newborn. If pneumobilia is identified in the newborn, although the possibility is low, clinicians should consider incompetence of the sphincter of Oddi with duodenal obstruction as well as portal vein gas.
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Fan WJ, Liu M, Feng XX. Endoscopic and surgical treatment of jejunal gallstone ileus caused by cholecystoduodenal fistula: A case report. World J Clin Cases 2023; 11:4159-4167. [PMID: 37388782 PMCID: PMC10303605 DOI: 10.12998/wjcc.v11.i17.4159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/16/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Gallstone ileus is a rare complication of gallstone disease in which a stone enters the enteric lumen and causes mechanical obstruction usually by bilioenteric fistula. Gallstone ileus accounts for 25% of all bowel obstructions among the population > 65 years of age. Despite medical advances over the last decades, gallstone ileus is still associated with high rates of morbidity and mortality.
CASE SUMMARY An 89-year-old man with a history of gallstones was admitted to the Gastroenterology Department of our hospital, complaining of vomiting and cessation of bowel movements and flatus. Abdominal computed tomography showed cholecystoduodenal fistula and upper jejunum obstruction due to gallstones, pneumatosis in the gallbladder, and pneumobilia indicating Rigler’s triad. Considering the high risk of surgical management, we performed propulsive enteroscopy and laser lithotripsy twice to relieve the bowel occlusion. However, the intestinal obstruction was not relieved by the less invasive procedure. Then, the patient was transferred to the Department of Biliary-pancreatic Surgery. The patient underwent the one-stage procedure including laparoscopic duodenoplasty (fistula closure), cholecystectomy, enterolithotomy, and repair. After surgery, the patient presented with complications of acute renal failure, postoperative leak, acute diffuse peritonitis, septicopyemia, septic shock, and multiple organ failure, and finally died.
CONCLUSION Early surgical intervention is the mainstay of treatment for gallstone ileus. For elderly patients with significant comorbidities, enterolithotomy alone is advised.
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Affiliation(s)
- Wen-Juan Fan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Mei Liu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xin-Xia Feng
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Sundaram KM, Morgan MA, Itani M, Thompson W. Imaging of benign biliary pathologies. Abdom Radiol (NY) 2023; 48:106-126. [PMID: 35201397 DOI: 10.1007/s00261-022-03440-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 01/21/2023]
Abstract
Pathologies of the biliary tree include a wide-spectrum of benign and malignant processes. The differential for benign disease includes congenital and acquired disease with variable prognosis and management pathways. Given the ability to mimic malignancy, benign processes are difficult to diagnose by imaging. Direct cholangiography techniques with tissue sampling are the gold standards for the diagnosis of benign and malignant biliary pathologies. Non-invasive imaging with ultrasound offers a first-line diagnostic tool while MRI/MRCP offers higher specificity for identifying underlying pathology and distinguishing from malignant disease. In this review, we focus on the imaging appearance of dilatation, cystic anomalies obstruction, inflammation, ischemia, strictures, pneumobilia, and hemobilia to help construct a differential for benign processes.
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Affiliation(s)
- Karthik M Sundaram
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Matthew A Morgan
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA
| | - Malak Itani
- Mallinkckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, USA
| | - William Thompson
- Department of Radiology, University of New Mexico, Albuquerque, USA
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Lee HL, Fu CK. Acute cholangitis detected ectopic ampulla of Vater in the antrum incidentally: A case report. World J Clin Cases 2021; 9:3379-3384. [PMID: 34002148 PMCID: PMC8107914 DOI: 10.12998/wjcc.v9.i14.3379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/22/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The ampulla of Vater is an opening at the confluence of the common bile duct and pancreatic duct. It is located in the second portion of the duodenum. An ectopic papilla of Vater is an anomalous termination. Few cases have been reported. We report the rare case of a man with an ectopic ampulla of Vater in the pylorus.
CASE SUMMARY An 82-year-old man had experienced abdominal pain and fever with chills 1 d before his presentation. A computed tomography scan of the abdomen demonstrated dilatation of the common bile duct approximately 2.2 cm in width. Gas retention was found in his intrahepatic ducts. Acute cholangitis with pneumobilia was identified, and he was hospitalized. Esophagogastroduo-denoscopy and endoscopic retrograde cholangiopancreatography disclosed no ampulla of Vater in the second portion of the duodenum. Moreover, a capsule-like foreign body (pharmaceutical desiccant) approximately 1 cm × 2 cm in size was found at the gastric antrum and peri-pyloric region. After the foreign body was removed, one orifice presented over the pyloric ring in the stomach, a suspected ectopic ampulla of Vater. Subsequently, sludge in the common bile duct was cleaned, and balloon dilatation was performed. The general condition improved daily. The patient was discharged in a stable condition and followed in our outpatient department.
CONCLUSION This case involved an ampulla of Vater in an unusual location. Endoscopic retrograde cholangiopancreatography with balloon dilatation is the main treatment recommended and performed.
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Affiliation(s)
- Hsu-Lin Lee
- Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung 411, Taiwan
- Department of Internal Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Chun-Kai Fu
- Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung 411, Taiwan
- Department of Internal Medicine, National Defense Medical Center, Taipei 114, Taiwan
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Abstract
Gallstone ileus is a rare cause of bowel obstruction, which mainly affects the elderly population. The associated mortality is estimated to be up to 30%. The presentation of gallstone ileus is notoriously non-specific, and this often contributes to the delay in diagnosis. The diagnosis of gallstone ileus relies on a radiological approach, and herein we discuss the benefits and drawbacks of the use of different modalities of radiological imaging: plain abdominal films, computed tomography, magnetic resonance imaging, and ultrasound scanning. Based on our case experience and review of the literature, the authors conclude that although an effective first-line tool, plain abdominal films are not adequate for diagnosing gallstone ileus. In fact, the gold standard in an acutely unwell patient is computed tomography.
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Affiliation(s)
- Liisa Chang
- Department of General Surgery, St. George's Hospital NHS Trust, London, UK.
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK.
| | - Minna Chang
- Faculty of Medicine, Imperial College London, South Kensington Campus, London, UK
| | - Hanna M Chang
- Faculty of Medicine, Imperial College London, South Kensington Campus, London, UK
| | - Aina I Chang
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Fuju Chang
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Department of Cellular Pathology, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK
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Abstract
Gallstone ileus is a rare disease that accounts for 1–4% of intestinal obstructions. Almost exclusively a condition in the older female population, it is a difficult diagnosis to make. We report the case of gallstone ileus in a 94-year-old Caucasian female, who presented to the emergency department with acute-onset nausea, coffee-ground emesis, lack of bowel movement, and abdominal distension. On CT scan, the diagnosis of gallstone ileus was made by the presence of a cholecystoduodenal fistula, pneumobilia, and small bowel obstruction. Emergent laparotomy with a one-stage procedure of enterolithotomy and stone removal by milking the bowel distal to the stone were performed. The postoperative course was uneventful until postoperative day 4 when the patient was found tachycardic, lethargic, and unresponsive. We reviewed the literature on the diagnosis and treatment of gallstone ileus.
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Affiliation(s)
- Estela Abich
- Florida State University College of Medicine, Fort Pierce, Florida, USA
| | - Daniel Glotzer
- Florida State University College of Medicine, Fort Pierce, Florida, USA
| | - Edward Murphy
- Florida State University College of Medicine, Fort Pierce, Florida, USA
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Abstract
Differentiating hepatic portal venous gas (HPVG) and pneumobilia on the CT scan can be accomplished by comparing the pattern of intrahepatic air spread. HPVG can be an indicator of significant intra-abdominal pathology and bowel ischaemia is the most common causative etiology for HPVG.
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Affiliation(s)
- Wai Cheong Soon
- Department of Radiology, Charing Cross Hospital St Dunstans Road, W6 8RF, London, UK
| | - Kevin Yifei Liu
- Department of Radiology, Charing Cross Hospital St Dunstans Road, W6 8RF, London, UK
| | - Dominic Blunt
- Department of Radiology, Charing Cross Hospital St Dunstans Road, W6 8RF, London, UK
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Thomas S, Patel RP, Oto A. Resolution of pneumobilia as a predictor of biliary stent occlusion. Clin Imaging. 2015;39:650-653. [PMID: 25892599 DOI: 10.1016/j.clinimag.2015.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 03/17/2015] [Accepted: 03/27/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To predict biliary stent occlusion on computed tomography (CT) from the loss of pneumobilia. METHODS A total of 66 patients with common bile duct stents with pneumobilia after initial stent placement had a follow-up CT and diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Two readers evaluated all CT exams for pneumobilia. Resolution or decrease of pneumobilia on CT was compared with ERCP findings. RESULTS Sensitivity and specificity was 60-64% and 95% with a positive predictive value of 97% and a negative predictive value of 49-51%. CONCLUSION Resolution or reduction of pneumobilia after stent placement is specific (95%) and is moderately accurate (70-73%) for predicting biliary stent occlusion.
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Abstract
Sump syndrome is a rare long-term complication of side-to-side choledochoduodenostomy (CDD), a common surgical procedure in patients with biliary tract disease in the era before endoscopic retrograde cholangiopancreatography (ERCP). Frequently only pneumobilia, serving as sign for functioning biliary-enteric anastomosis, is reminiscent of the former surgery. We present the case of an 81-year-old patient with sump syndrome who presented with clinical signs of ascending cholangitis, decades after the initial CDD procedure. Finally the detailed medical history that was taken very thoroughly in combination with the presence of pneumobilia led to the suspicion of sump syndrome. Sump syndrome was diagnosed by ERCP, and after endoscopic debris extraction and antibiotic treatment the patient recovered quickly. In the ERCP era little is known about CDD and its long-term complications, especially by young colleagues and trainees. Therefore this report provides an excellent opportunity to refresh the knowledge and raise awareness for this syndrome.
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Affiliation(s)
- Ulf Zeuge
- Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Martin Fehr
- Division of Medical Oncology/Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christa Meyenberger
- Division of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Michael Christian Sulz
- Division of Gastroenterology and Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Abstract
The case of a 77-year-old woman with symptoms of gastric outlet obstruction is presented. Transabdominal ultrasonography findings were suspicious of Bouveret's syndrome. Upper endoscopy confirmed this diagnosis. Bouveret's syndrome is a rare complication of gallstone disease caused by a bilioenteric fistula leading to gastric outlet obstruction by a gallstone and should be suspected in any patient who presents with pneumobilia without recent endoscopic retrograde cholangiopancreatography or biliary surgery.
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Affiliation(s)
- Martina Keller
- Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Carola Epp
- Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christa Meyenberger
- Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Michael Christian Sulz
- Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Tandon A, Usha T, Bhargava SK, Bhatt S, Bhargava S, Prakash M, Durgadas AA. Resolution of gallstone ileus with spontaneous evacuation of gallstone: a case report. Indian J Surg 2013; 75:228-31. [PMID: 24426434 DOI: 10.1007/s12262-013-0818-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 01/15/2013] [Indexed: 10/27/2022] Open
Abstract
Gallstone ileus is an infrequent complication of cholelithiasis. The formation of a fistula between the gallbladder and duodenum may allow a gallstone to enter the gastrointestinal (GI) tract. Gallstone ileus generally occurs in the elderly patients and is associated with significant mortality. Spontaneous resolution of gallstone ileus after passage of gallstone per rectally, though rare, has been reported Farooq et al. (Emerg Radiol 4(6):421-423, 2007). We describe a 60-year-old woman who presented with a 3-day history of vomiting, pain, distension and constipation .Radiological investigations revealed dilatation of small bowel loops with multiple air fluid levels with a large lamellated radio-opaque density measuring 4.4 cm × 4 cm seen in the right iliac fossa. A possibility of gallstone ileus was kept. Because of co-morbid conditions (post-myocardial infarct with cardiac failure), surgery could not be done and patient was kept on conservative management. Three days later patient had sudden relief of her symptoms after passing a large calculus per rectally suggesting a spontaneous evacuation of gallstone. This case highlights the possibility of spontaneous resolution of gallstone ileus after the passage of gallstone. It has been reported in stones less than 2.5 cm. However, to the best of our knowledge, this is the first time in which a large stone measuring 4 cm × 3.8 cm passed spontaneously.
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Singal R, Gupta P, Dwivedi S, Mittal A, Kohli S, Gupta S. An unforgettable concurrence: Successfully managed gallstone ileus accompanied by diabetic nephropathy. J Res Med Sci 2012; 17:412-5. [PMID: 23267408 PMCID: PMC3526140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 03/03/2012] [Accepted: 04/12/2012] [Indexed: 11/02/2022]
Abstract
BACKGROUND Gallstone ileus is an uncommon complication of gall stones associated with potentially serious morbidity and mortality. CASE REPORT We reported a 60-year-old male case who presented with renal failure and pain in right hypochondriac region. He also had a history of brain infarcts along with diabetes which is an additional factor for mortality. On Computed Tomography of the abdomen, he was diagnosed to have cholecystocholedochal fistula including air in the gall bladder and obstruction in the distal part of the ileum. Computed tomography plays an important role to make the proper diagnosis and in treatment. CONCLUSIONS As in our case, diagnosis was challengeable because of renal failure,diabetes, septicaemia and intestinal obstruction (peritonitis). We did surgery on the basis of peritonitis which remains the only choice in such cases. In follow- up of 1 month patient was doing well and asymptomatic.
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Affiliation(s)
- Rikki Singal
- Associate Professor, Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana, India,Address for correspondence: Rikki Singal, C/O Dr Kundan Lal Hospital, Ahmedgarh, Distt-Sangrur, Punjab, India, Pin Code-148021. E-mail:
| | - Parveen Gupta
- Associate Professor, Department of Medicine, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana, India
| | - Sankalp Dwivedi
- Professor, Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana, India
| | - Amit Mittal
- Associate Professor, Department of Radiodiagnosis, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana, India
| | - Sudha Kohli
- Professor, Department of Anesthesia, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana, India
| | - Samita Gupta
- Post Graduate Resident, Department of Radiodiagnosis, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana, India
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Howley I, Gregg SC, Heffernan DS, Adams CA. Peritoneal free air due to evacuation of pneumobilia in blunt abdominal trauma. J Emerg Trauma Shock 2010; 3:412-5. [PMID: 21063570 PMCID: PMC2966580 DOI: 10.4103/0974-2700.70777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 07/19/2010] [Indexed: 11/12/2022] Open
Abstract
Pneumobilia is mostly observed on computed tomography (CT) following surgical biliary-enteric anastomosis and biliary manipulation through endoscopic procedures. Although pneumobilia can be seen in pathological conditions, post-surgical pneumobilia is typically not associated with morbidity. In the present article, we report a case in which blunt abdominal trauma led to the evacuation of pre-existing pneumobilia causing pneumoperitoneum. Given that the subsequent laparotomy proved to be non-therapeutic, this report adds to the few cases of intra-peritoneal free air not helped by surgical intervention.
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Affiliation(s)
- Isaac Howley
- Department of Surgery, Rhode Island Hospital and the Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA
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Savvidou S, Goulis J, Gantzarou A, Ilonidis G. Pneumobilia, chronic diarrhea, vitamin K malabsorption: A pathognomonic triad for cholecystocolonic fistulas. World J Gastroenterol 2009; 15:4077-82. [PMID: 19705508 PMCID: PMC2731963 DOI: 10.3748/wjg.15.4077] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cholecystocolonic fistula (CF) is an uncommon type of internal biliary-enteric fistulas, which comprise rare complications of cholelithiasis and acute cholecystitis, with a prevalence of about 2% of all biliary tree diseases. We report a case of a spontaneous CF in a 75-year-old diabetic male admitted to hospital for the investigation of chronic watery diarrhea and weight loss. Massive pneumobilia demonstrated on abdominal ultrasound and computerized tomography, along with chronic, bile acid-induced diarrhea and a prolonged prothrombin time due to vitamin K malabsorption, led to the clinical suspicion of the fistula. Despite further investigation with barium enema and magnetic resonance cholangio-pancreatography, diagnosis of the fistulous tract between the gallbladder and the hepatic flexure of the colon could not be established preoperatively. Open cholecystectomy with fistula resection and exploration of the common bile duct was the preferred treatment of choice, resulting in an excellent postoperative clinical course. The incidence of biliary-enteric fistulas is expected to increase due to the parallel increase of iatrogenic interventions to the biliary tree with the use of endoscopic retrograde cholangio-pancreatography and the increased rate of cholecystectomies performed. Taking into account that advanced imaging techniques fail to demonstrate the fistulas tract in half of the cases, and that CFs usually present with non-specific symptoms, our report could assist physicians to keep a high index of clinical suspicion for an early and valid diagnosis of a CF.
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Abstract
Gallstone ileus is a rare disease and accounts for 1%-4% of all cases of mechanical intestinal obstruction. It usually occurs in the elderly with a female predominance and may result in a high mortality rate. Its diagnosis is difficult and early diagnosis could reduce the mortality. Surgery remains the mainstay of treatment. We report two cases of gallstone ileus. The first was a 78-year old woman who had a 2-d history of vomiting and epigastralgia. Plain abdominal film suggested small bowel obstruction clinically attributed to adhesions. Later on, gallstone ileus was diagnosed by abdominal computed tomography (CT) based on the presence of pneumobilia, bowel obstruction, and an ectopic stone within the jejunum. She underwent emergent laparotomy with a one-stage procedure of enterolithotomy, cholecystectomy and fistula repair. The second case was a 76-year old man with a 1-wk history of epigastralgia. Plain abdominal film showed two round calcified stones in the right upper quadrant. Fistulography confirmed the presence of a cholecystoduodenal fistula and gallstone ileus was also diagnosed by abdominal CT. We attempted to remove the stones endoscopically, but failed leading to an emergent laparotomy and the same one-stage procedure as for the first case. The postoperative courses of the two cases were uneventful. Inspired by these 2 cases we reviewed the literature on the cause, diagnosis and treatment of gallstone ileus.
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Affiliation(s)
- Jen-Wei Chou
- Division of Gastroenterology, Department of Internal Medicine, China Medical University Hospital, No.2, Yuh-Der Road, North District, Taichung 40447, Taiwan, China
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Shirbur SN, Ramachandran H, Gokhale S, Falleiro J. UNUSUAL BILIARY FISTULA. Med J Armed Forces India 2001; 57:167-8. [PMID: 27407329 PMCID: PMC4925849 DOI: 10.1016/s0377-1237(01)80146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Agenesis of gall bladder is a clinical rarity, as most of the diagnoses are made at autopsy. Preoperative diagnosis of this anomaly is fraught with follies. External biliary fistulae are usually result of complications of trauma or biliary surgery. Internal fistulae on the other hand may result from erosion of wall by a stone, cancerous growth or peptic ulcer. Sites of opening of internal fistulae are stomach, duodenum, jejunum, ileum or colon. These should be suspected if gas shadows are seen in biliary tree.
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Affiliation(s)
- S N Shirbur
- Classified Specialist (Surgery), Military Hospital Bareilly Cantt (UP) 243 001
| | - H Ramachandran
- Senior Advisor (Surgery), Military Hospital Bareilly Cantt (UP) 243 001
| | - S Gokhale
- Classified Specialist (Path & Microbiology), Military Hospital Bareilly Cantt (UP) 243 001
| | - J Falleiro
- Classified Specialist (Pathology). Military Hospital Bareilly, Cantt (UP) 243 001
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