gallstone ileus
Introduction
Introduction to gallstone intestinal obstruction Gallstone intestinal obstruction is an intestinal obstruction caused by intestinal obstruction caused by gallstones entering the biliary tract. It was first reported by Bartholin in 1654. The disease is rare in clinical practice, and the onset is insidious. The initial stage of the disease is often intermittent, and X-ray examination is not typical of every patient. Only 10% to 75% of patients are diagnosed before surgery. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific people Mode of infection: non-infectious Complications: volvulus
Cause
Causes of gallstone intestinal obstruction
(1) Causes of the disease
The cause of gallstone intestinal obstruction is that the huge gallstone enters the intestine. The diameter of the stone that can cause obstruction of the intestinal lumen is generally above 2.5 cm. Turner reported that the diameter of one case is 17.7 cm.
1. Abnormal channels between the biliary tract and the gastrointestinal tract: this is the pathological basis of gallstone intestinal obstruction. Common biliary-gastrointestinal tract abnormalities include: common bile duct-duodenal fistula, gallbladder-twelve Intestinal fistula, gallbladder-colon fistula, gallbladder-gastric fistula, common bile duct-duodenal fistula, etc., of which gallbladder-duodenal fistula accounts for about 3/4, Hu Guobin and others have treated 1 patient with hepatolithiasis. It was found that there was a huge internal fistula between the left hepatic duct and the stomach, and the stone could enter the intestine through the fistula.
2. Iatrogenic factors: such as hepatolithiasis after biliary drainage, the purpose of internal drainage is to reconstruct unobstructed bile drainage, the essence of which is equivalent to artificially formed biliary fistula, in order to facilitate the passage of stones, Hunan Province The People's Hospital has reported a case of biliary ileus obstruction after hepatic bile duct drainage.
(two) pathogenesis
Most of the gallstones causing obstruction are only one, but there are more than 3% to 15% of patients. Gallstone obstruction can occur in any part of the intestine, but it is most likely to occur at the end of the ileum, accounting for 58% to 85%. The gallstone enters the intestine and first blocks in the proximal end of the intestine. As the stone decreases, the obstruction plane gradually decreases. The stone can compress the intestinal wall, causing ischemia, and the intestinal wall is exuded. The proximal dilated intestine can be Excessive fluid accumulation, followed by necrosis of the ischemic intestinal wall, perforation, intestinal secretions leaking out of the intestinal lumen into the abdominal cavity, forming diffuse peritonitis.
Prevention
Prevention of gallstone intestinal obstruction
prevention:
(1) Regular eating (three meals a day) is the best way to prevent stones, because the gallbladder is filled with bile during fasting, and the gallbladder mucosa absorbs water to make the bile thicker. At this time, cholesterol/lecithin is easy to bubble. Formed, the viscosity of the bile increased, and finally formed a biliary mud. If eaten, when the food enters the duodenum, the gallbladder contraction hormone is reactively secreted, causing the gallbladder to contract, and a large amount of bile that is viscous and watery with bile is discharged into the intestine. Therefore, the formation of stones can be prevented.
(2) Choose a reasonable diet to avoid high protein, high fat, high calorie eating habits. Appropriately eat a fiber-rich diet to improve cholesterol excretion and prevent the formation of stones.
Complication
Complications of gallstone intestinal obstruction Complications
In the latter part of the course of the disease, complications such as intestinal torsion, intestinal narrowing, and intestinal perforation may occur.
Symptom
Symptoms of gallstone obstruction Common symptoms Plate-shaped abdominal distension Abdominal tenderness Colonic obstruction Aphid intestinal obstruction Astragalus nausea Stops exhaust
Clinical manifestations of acute or chronic, high or low, partial or complete intestinal obstruction, its symptoms and signs are similar to mechanical intestinal obstruction caused by other causes, the initial stage of the disease is partial obstruction, the symptoms are light, manifested as bursts Sexual abdominal cramps, accompanied by nausea and vomiting, which is caused by gallstone blockage of the proximal lumen of the lumen, which stimulates the intestinal tract to produce strong intestinal peristalsis. As the stone decreases, the obstruction plane decreases, and the symptoms also follow the progression of the disease. Changes, such as anal stop exhaust defecation, abdominal distension, progressive abdominal tenderness, platy abdomen, a small number of patients with jaundice and gastrointestinal bleeding, symptoms and signs with the progression of the disease is a characteristic manifestation of the disease.
Examine
Examination of gallstone intestinal obstruction
Abdominal X-ray examination can have 4 features:
1 intestinal obstruction, because most of the stones are small and smooth, can gradually move down in the intestine, so the obstruction is mostly incomplete, and the obstruction point changes more, but the small intestine is low, the ileocecal valve is often the obstruction point (Figure 1A) ), the obstruction is mostly in the small intestine, and the colonic obstruction is only 2% to 8% in different literatures.
2 gallbladder, bile duct gas accumulation, bile duct gas accumulation, can be a thick tube, there may be small branches, because there are many bile duct obstruction before obstruction, so the bile duct is larger than normal, usually looser than Oddi sphincter, biliary aphid belt The gas or other causes are more complicated with the bile duct gas produced by the intestinal fistula, biliary-gastrointestinal anastomosis, etc., for identification.
3 Intestinal gallstones, about 50% of gallstones can be developed under X-ray, and some develop lighter, so about half of gallstone intestinal obstruction only has intestinal obstruction and biliary gas accumulation without seeing gallstone.
4 barium meal or barium enema examination see the sputum into the biliary tract or directly set off the biliary stone shadow.
Diagnosis
Diagnosis and diagnosis of gallstone intestinal obstruction
Diagnostic criteria
1. History: Old age, obese women, have a history of cholelithiasis.
2. Clinical manifestations: There are acute or chronic, high or low, partial or complete intestinal obstruction symptoms and signs, the symptoms at the beginning of the disease are lighter, with the stones continue to move down, the obstruction plane gradually declines, symptoms and signs also follow the course of the disease The progress of the change, this is a characteristic manifestation of the disease.
3. Auxiliary examination: There are 4 signs in X-ray examination:
1 partial or complete intestinal obstruction;
2 biliary gas accumulation;
3 ectopic, that is, there is a gallstone shadow in the area outside the biliary system;
4 barium meal or barium enema examination see the sputum into the biliary tract or directly set off the biliary stone shadow.
Differential diagnosis
In the case of complications, the disease is easily confused with intussusception, perforation of the digestive tract ulcers, etc., should be noted for identification.
