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Gallstone Ileus in a 98-year-old Woman
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Veröffentlicht: | 26. April 2013 |
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Introduction: Gallstone ileus is a rare but serious complication of cholelithiasis, resulting from a fistula between the gallbladder and the gastrointestinal tract. Symptoms may comprise the classical Rigler’s triad of aerobilia, small bowel obstruction and gallstones.
Material and methods: A 98-year-old woman was admitted to hospital with a 24-hour history of epigastric pain and vomiting. Physical examination, ultrasonography, CT scan and laboratory test were carried out for diagnosis.
Results: Physical examination was unremarkable, however ultrasonography revealed a positive Murphy’s sign along with extrahepatic cholestasis, aerobilia and a fistulous communication between the gallbladder and the duodenum. CT scan furthermore showed an obstructing 4.2 cm x 2.8 cm calcified hyperdense lesion within the jejunum as well as a prestenotic dilated- and poststenotic collapsed segment of small bowel. Laboratory test indicated a leucocytosis of 12,900/µl and an elevated C-reactive-protein of 2.08mg/dl. The patient underwent emergency surgery with successful removal of the gallstone in the jejunum. The cholecystoduodenal-fistula was left untapped. After an uneventful recovery the patient was discharged home on postoperative day thirteen. Figure 1 [Fig. 1].
Conclusion: Even in elderly patients, immediate diagnosis and transfer to emergency surgery are indispensable for an uneventful course of disease as well as an optimal prognosis.