Sangrado de tubo digestivo y delirium, retos en el diagnóstico de íleo biliar: reporte de un caso y revisión de bibliografía

Abstract

Gallstone ileus is a rare pathology, difficulty in diagnosis prolongs hospital stay, which directly influences mortality.

Gallstone ileus: the importance of individualized management

“…Due to the fact that in our country the population over 65 years of age has increased, it is to be expected that GI occurs more frequently nowadays, sometimes associated with other diseases that make its diagnosis and treatment difficult, such as digestive tract bleeding, delirium, colon neoplasia, amyotrophic lateral sclerosis, and it should not be forgotten that, although less frequently, it occurs in young patients. [7][8][9][10] Once the challenge of diagnosis has been overcome, we are faced with the dilemma of treatment. In the present case, we opted for the open approach with the only entero-lithotomy; this approach is associated with a 4.9% mortality, although it should be taken into account that GI can recur in 5-33% of patients treated in this way.…”

“…4,5 The clinical picture is characterized by abdominal pain accompanied by symptoms of intestinal obstruction with several days of evolution (4-8 days). [6][7][8] Preoperative diagnosis can be made employing plain radiography in 10-20% and by contrast tomography in 77% of cases, in which Rigler's triad (small bowel obstruction, pneumobilia, and ectopic gallstone) is evident. 2 Usually, it is diagnosed in 50% of cases during the intraoperative period, 6 it is then when the surgeon is faced with the decision to perform the only entero-lithotomy, enterolithotomy with cholecystectomy at the same time, or entero-lithotomy with delayed cholecystectomy.…”

Manejo cirúrgico da obstrução intestinal por íleo biliar

“…A dor abdominal é generalizada, em cólicas e normalmente associada a náuseas e vômitos, os quais podem ser biliosos (obstrução do intestino delgado) ou fecaloides (obstrução do intestino grosso). Por outro lado, a distensão ocorre devido a obstrução do estômago distal ou do bulbo duodenal, sendo um sinal variável e possivelmente acompanhado da ausência de sons ou ruídos intestinais agudos, ao exame físico (AGUILAR-ESPINOSA et al, 2017;CHANG et al, 2017;FERHATOGLU;KARTAL, 2018).…”

Sangrado de tubo digestivo alto debido a fistula colecistoduodenal: Hallazgo quirúrgico

“…El diagnóstico de la fístula colecistoentérica es difícil y tardío en la mayoría de las ocasiones, debido a que las fístulas se forman de manera insidiosa, mientras que los síntomas de los pacientes son inespecíficos y superpuestos debido a la presencia de múltiples patologías [16]. Usualmente, las fístulas se descubren de manera incidental durante la cirugía de urgencia por complicaciones como obstrucción intestinal por íleo biliar y/o sangrado duodenal masivo, dejando un margen terapéutico estrecho que empeora el pronóstico del paciente.…”