gms | German Medical Science

130. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

30.04. - 03.05.2013, München

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Gallstone Ileus in a 98-year-old Woman

Meeting Abstract

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  • Barbara Kern - Medizinische Universität Innsbruck, Visceral,- Transplantations,- Thoraxchirurgie, Innsbruck
  • Robert Sucher - Medizinische Universität Innsbruck, Visceral,- Transplantations,- Thoraxchirurgie, Innsbruck
  • Bernhard Glodny - Medizinische Universität Innsbruck, Radiologie, Innsbruck
  • Pamela Kogler - Medizinische Universität Innsbruck, Visceral,- Transplantations,- Thoraxchirurgie, Innsbruck
  • Stefan Schneeberger - Medizinische Universität Innsbruck, Visceral,- Transplantations,- Thoraxchirurgie, Innsbruck
  • Johann Pratschke - Medizinische Universität Innsbruck, Visceral,- Transplantations,- Thoraxchirurgie, Innsbruck
  • Robert Öllinger - Medizinische Universität Innsbruck, Visceral,- Transplantations,- Thoraxchirurgie, Innsbruck

Deutsche Gesellschaft für Chirurgie. 130. Kongress der Deutschen Gesellschaft für Chirurgie. München, 30.04.-03.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13dgch266

doi: 10.3205/13dgch266, urn:nbn:de:0183-13dgch2666

Veröffentlicht: 26. April 2013

© 2013 Kern et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.

Gliederung

Text

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.