Nature clinical practice. Gastroenterology & hepatology · 2005
Diagnosis and treatment of a patient with gallstone ileus.
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Zuber-Jerger Ina, Kullmann Frank, Schneidewind Arno, Schölmerich Jürgen
Аннотация
BACKGROUND: A 79-year-old white woman presented with upper abdominal pain. She had a history of rheumatoid arthritis since she was 19 years old, which was treated with prednisolone, leflunomide, diclofenac and pantoprazole. She also had factor VII deficiency. The patient had been hospitalized 2 months previously with sepsis presumed to be due to urinary infection, and was treated with antibiotics. Sonography at this time revealed a gallbladder with a monstrous thick wall and stones, and the first differential diagnosis was cholecystitis. Cholecystectomy was planned after amelioration of the patient's general state, but her general state worsened.
INVESTIGATIONS: Sonography, endoscopy of the upper and lower intestine, and CT scan.
DIAGNOSIS: Biliodigestive fistula and gallstone ileus.
MANAGEMENT: Enterolithotomy, stenting, endoscopic retrograde cholangiopancreatography, and surgery.
INVESTIGATIONS: Sonography, endoscopy of the upper and lower intestine, and CT scan.
DIAGNOSIS: Biliodigestive fistula and gallstone ileus.
MANAGEMENT: Enterolithotomy, stenting, endoscopic retrograde cholangiopancreatography, and surgery.