EMERGENCY ABDOMINAL ULTRASOUND AS SUFFICIENT DIAGNOSTIC MODALITY IN THE DIAGNOSIS OF BILIARY ILEUS

Milica Mitrovic, Nevena Stanisic, Zlatko Perisic, Ivana Lesevic, Dragan Vasin, Krstina Doklestic

Abstract


Introduction: Biliary ileus is a rare emergency condition that mainly affects the elderly population, with a predominance of females and a mortality rate of 12-27%. It is a mechanical intestinal obstruction caused by the impaction of the biliary calculus within the gastrointestinal tract. It occurs due to the formation of bilio-enteric fistula, as a rare complication of cholelithiasis.

Case report: A 73-year-old male patient with epigastric pain, nausea and vomiting was referred for ultrasound exam. The analysis of the clinical-biochemical status of the patient as well as the ultrasound examination of the abdomen itself raised the suspicion of small intestine obstruction, due to the enclaved biliary calculus. After an urgent exploratory laparotomy, the diagnosis was confirmed, and enterotomy was successfully performed with calculus extraction. Cholecysto-duodenal fistula has been confirmed as a major cause of biliary ileus. The post-operative course was uneventful.

Conclusion: This case report highlights the enormous importance of ultrasound diagnostics in diagnosing biliary ileus using the criteria of The Rigler Triad, which includes pneumobilia, intestinal obstruction and ectopic calculus. Initialy unrecognisied cause of obstruction and a late diagnosis correlated with bad prognosis. Ultrasonographic examination of these patients, can be a sufficient diagnostic modality in making an accurate diagnosis and further surgical treatment of these patients.


Keywords


cholelithiasis, biliary ileus, ultrasonographic examination of the abdomen

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References


Farrell I, Turner P. A simple case of gallstone ileus? J Surg Case Rep. 2015;1:1-3.

Ploneda-Valencia CF, Gallo-Morales M, Rinchon C, NavarroMuniz E, Bautista-Lopez CA, de la Cerda-Trujillo LF et al. Gallstone ileus: an overview of the literature. Rev Gastroenterol Mex. 2017;82(3):248-54.

Sahsamanis G, Maltezos K, Dimas P, Tassos A, Mouchasiris C. Bowel obstruction and perforation due to a large gallstone. A case report. Int J Surg Case Rep. 2016;26:193–6.

Halabi WJ, Kang CY, Ketana N, Lafaro KJ, Nguyen VQ, Stamos MJ et al. Surgery for gallstone ileus: a nationwide comparison of trends and outcomes. Ann Surg. 2014;259(2):329–35.

Chuah PS, Curtis J, Misra N, Hikmat D, Chawla S. Pictorial review: the pearls and pitfalls of the radiological manifestations of gallstone ileus. Abdom Radiol (NY). 2017; 42(4):1169–75.

Nuno-Guzman CM, Marín-Contreras ME, Figueroa-Sanchez M, Corona JL. Gallstone ileus, clinical presentation, diagnostic and treatment approach. World J Gastrointest Surg. 2016; 8(1):65–76.

Liisa C, Minna C, Hanna MC, Aina IC, Fuju C. Clinical and radiological diagnosis of gallstone ileus: a mini review. Emerg Radiol. 2018; 25(2):189–96.

O'Brien JW, Webb LA, Evans L, Speakman C, Shaikh I. Gallstone ileus caused by cholecystocolonic fistula and gallstone impaction in the sigmoid colon: review of the literature and novel surgical treatment with trephine loop colostomy. Case Rep Gastroenterol.2017;11(1):95–102.

Howells L, Liasis L, Demosthenous M. Gallstone coleus: a rare relation of gallstone ileus. Int J Surg Res. 2015; 2(4):28–31.

Bruni SG, Pickup M, Thorpe D. Bouveret’s syndrome - a rare form of gallstone ileus causing death: appearance on postmortem CT and MRI. BJR Case Rep.2017; 3(3):20170032. doi: 10.1259/bjrcr.20170032.

Jakubauskas M, Luksaite R, Sileikis A, Strupas K, Poskus T. Gallstone Ileus: Management and clinical outcomes. Medicina (Kaunas). 2019;55(9):598.

Rami Reddy SR, Cappell MS. A systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction. Curr Gastroenterol Rep. 2017;19(6):28.

Rotaru MI, Necula AH, Caraiani CN, Badea AF, Tantau MV, Badea RI. Point-of-care ultrasound in management of gallstone ileus - a case report. Med Ultrason. 2019;21(2):197-9.

Bakhshi GD, Chincholkar RG, Agarwal JR, Gupta MR, Gokhe PS, Nadkarni AR. Gallstone ileus: dilemma in the management. Clin Pract. 2017;7(3):977.

Salazar-Jimenez MI, Alvarado-Duran J, Fermín-Contreras MR, Rivero-Yanez F, Lupian-Angulo AI, Herrera-Gonzalez A. Ileo biliar, revision del manejo quirurgico [Gallstone ileus, surgical management review]. Cir Cir. 2018;86(2):182-6. Spanish.




DOI: http://dx.doi.org/10.24125/sanamed.v15i3.476

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