| 摘要 |
was presented to the emergent department because of intermittent abdominal pain for 3 days. The associated symptoms were abdominal fullness and postprandial vomiting. The radiography of abdomen showed dilated small bowel loops in the left upper quadrant abdomen and a radiopaque stone in the right lower quadrant of the abdomen [Figure 1a]. The abdominal computed tomography (CT) scan showed disappear of all gallstones from the gallbladder [Figure 2a], cholecystoduodenal fistula [Figure 2b], and a 3-cm gallstone in the lumen of terminal ileum [Figure 2c] resulted in proximal dilatation and distal collapse.
Tracing her previous abdominal radiography 10 months ago, a radiopaque stone was located in the right upper quadrant abdomen [Figure 1b]. The CT scan at that time showed distended gallbladder with big gallstone pushing the duodenum [Figure 3a and b]. Under the impression of gallstone ileus, emergent laparotomy was arranged. On exploration, a gallstone impacted in the distal small bowel resulted in proximal dilatation, and distal collapse
was noted. Due to difficulty in repelling the stone into colon, we made an enterotomy and removed the stone. We did not remove the gallbladder at the same time because there were no residual stones in it on CT scan. Besides, doing one‑stage procedure (including enterolithotomy, cholecystectomy and fistula closure) will need a long midline incision and longer operation
time. Hence, we chose only enterolithotomy to avoid possible complications related to one‑stage procedure.
After operation, the patient recovered well and was discharged on postoperative day 7. She is doing well 2 years after the operation. |
