Jejunum-Biliary Intestinal Obstruction - Case Report
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 6
Abstract
Introduction: Intestinal obstruction by a gallstone (biliary jejunum) is an uncommon and potentially serious omplication of chronin cholecystitis. Ileum gallstone represents 25% of non-strangulation obstructions in the small bowel causing 1% to 3% of all obstruction surgeries. Biliary ileum located in the proximal jejunum is a rare condition and the treatment post minimum invasive technic tends to be the best therapeutic option when available. Material and Method: case report of 87 years old female diagnosed with duodenum biliary post acute cholecystitis. Results: After frustrated attempt of gallstone removal by upper digestive endoscopy, the gallstone migrated to proximal jejunum. After observation expecting for the gallstone to evolve through the small bowel, surgery was opted due to the obstrucion maintenance. The patient was submitted for a videolaparoscopy to remove the 4 cm gallstone by enterotomy and enterorrhaphy. No complications were presented after surgery. Conclusion: The option for a videolaparcopy approach showed effective, even more in a elderly patient in a matter of fact of decrease morbidity and mortality related to the abdominal wall. Gallstone intestine obstruction, named by jejunobiliar (JB) ia an uncommon complication and a potentialchronic cholecystitis [1]. The autors presente a case of obstructive bowel by a gallstone located in the proximal intestine in a 87 years old patient with cholecystitisntreated by minimally invasive approach. Case Report Female, 87 years old with symptomatic cholecystitis interned in the hospital emergency with abdominal pain and vomit. Blood count presented an importante leucocytosis. Total abdominal ultrassonography was performed indicating gastric cavity distension containing residue in it’s interior; gallbladder non dilataded bile ducts (common bile duct measuring 0.5cm of diameter). A abdominal computed tomography (CT) identified a large gallstone in duodenal bulb interior in the first duodenal portion confluence, measuring between 2,5 to 3,5cm in it’s axial axis (Figure 1). The patient was submitted by an upper digestive endoscopy to remove the gallstone, wich was not successful (Figure 2). The gallstone migrated for the third duodenal portion (Figure 3). It was decided for a non opertative treatment, expecting the gallstone to decrease it’s volume through endoscopy manipulation and evoluing without surgery approach. On the sixth day of hospitalization, as the patient persisted with drainage of gastrointestinal secretion by naso-gastric probe, was performed another abdominal CT (Figure 4) demonstrateing a gallstone in the proximal jejunum It was opted foa a surgeric approach. The patient was submitted to a videolaparoscopy wich identified a gallstone in the proximaljejunum 10cm after the Treitz angle. The gallstone was removed by enterotomy (Figure 5). Cholecystectomy was not performed in this procedure. The patient presented a good postoperative evolution, being discharged in the second postoperative day.
Authors and Affiliations
Miguel Prestes Nácul, Marcelo Velloso Fabris, Ricardo Gonçalves Da Costa
Keywords
Related Articles
- EP ID EP572959
- DOI 10.26717/BJSTR.2017.01.000497
- Views 163
- Downloads 0
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