digestive 02

8/18/2019 Digestive 02

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#holesterol gallstones result from secretion by the liver of bilesupersaturated ith cholesterol

igment stones are blac$ to dar$ bron" +-5 mm in diameter" and

amorphous

#omposed of a mi)ture of calcium bilirubinate" comple) bilirubinpolymers" and bile acids

Bacteria have a primary role in pigment gallstone formation

allstone ileus is mechanical intestinal obstruction caused by alarge gallstone lodged in the lumen

t is seen most often in omen" and the average age is about 0

The obstructing gallstone enters the intestine through acholecystenteric 2stula located in the duodenum" colon" or"rarely" the stomach or (e(unum

3tones that cause gallstone ileus are almost alays +45 cm ormore in diameter


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Location of the cholecystenteric stula in the duodenum, colon, or, rarely, the stomach or jejunum

3ign and 3ymptom The patient usually presents ith obvious small boel

obstruction" either partial or complete *bdominal pain and vomiting hich subside as the

gallstone becomes disimpacted4 ematemesis could

occur as an occasional complication that is due tohemorrhage at the site of the biliary enteric 2stula

6igler7s Triad

- neumobilia- 3B8 %3mall Boel 8bstruction'- mpacted gallstone-usually in the terminal

ileum at ileocecal valve hysical 9)amination

The patient may be febrile and often appears dehydrated #ommon abdominal signs include distension and

increased boel sounds :aundice is uncommon" occurring in less than 15. of

cases

;iagnosis The most important diagnostic test is abdominal plain 2lm

ard to diagnose < previous series yield =,. to ,.

diagnosed preoperatively


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#T scan highly sensitive and accurate in pre-op diagnosis

of suspected intestinal obstruction

maging

Treatment 6elief intestinal obstruction after ade>uate uid repletion

;ebate involves need for de2nitive biliary tract surgery 9nterolithotomy alone to relieve obstruction ith biliary

tract surgery later (two stage procedure) or to performthe biliary tract surgery at the same sitting (one stageprocedure)

To stage! >uic$ relief mechanical obstruction avoid need

2stula e)ploration and reduces operative time- ?ost 2stulas close spontaneously if left alone- ublished reports sho loer mortality rate

11. in to stage procedure compared to@4 . for one stage procedure

;ilated small intestine

lain 2lms of the abdomen

may sho a radiopa>uegallstone

n about =0. of cases"

careful e)amination of the2lm ill reveal gas in the

biliary tree

Ahen the clinical picture isunclear" an uppergastrointestinal seriesshould be obtained" hich

ill demonstrate thecholecystoduodenal 2stulaand verify intestinalobstruction


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8ne 3tage! more technically dicult" reduces occurrence

recurrent gallstone ileus" cholecystitis and cholangitis

digestive 02

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