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Gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after bile duct cancer surgery: a case report.

Lee HG, Hwang S, Joo YH, Cho YJ, Choi K - Korean J Hepatobiliary Pancreat Surg (2015)

Bottom Line: Since the clinical manifestation was improved, we decided to observe her closely.She recovered and returned to normal life after 10 days of initiation of clinical manifestations.We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
The diagnosis of gallstone ileus is occasionally challenging due to the variability of its presentation. We herein present a very rare case of gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after 10 years of bile duct cancer surgery. We describe the case of a 74-year-old Korean woman with obstructive jaundice, treated conservatively. She showed severely impaired liver function test and obstructive jaundice. The computed tomography (CT) scan led to a diagnosis of very rare type of gallstones ileus at the afferent jejunal loop. Since the clinical manifestation was improved, we decided to observe her closely. On the next follow-up CT scan, the gallstone disappeared with mild distension of the afferent bowel loop, implicating spontaneous passage of the gallstone. She recovered and returned to normal life after 10 days of initiation of clinical manifestations. We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size. The presence of narrow tract of intestine may facilitate the incidence of gallstone ileus. It appears to be the first report on this rare type of gallstone ileus inducing obstructive jaundice.

No MeSH data available.


Related in: MedlinePlus

Follow-up computed tomography finding showing disappearance of intraluminal radiopaque lesion (A) with mild distension and edematous wall thickening of the afferent bowel loop (B).
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Figure 2: Follow-up computed tomography finding showing disappearance of intraluminal radiopaque lesion (A) with mild distension and edematous wall thickening of the afferent bowel loop (B).

Mentions: Since her symptoms of abdominal discomfort were not severe and her gross appearance was not so seriously ill with normal vital signs, we decided to observe her closely for 1 or 2 days. On follow-up of liver function tests, hepatic dysfunction improved rapidly, thus implicating spontaneous passage of gallstone impaction. After 3 days of admission, unenhanced follow-up CT scan was performed, in which intraluminal radiopaque lesion disappeared with mild distension and edematous wall thickening of the afferent bowel loop (Fig. 2). These findings implicate the gallstone was spontaneous passed through the bowel and then removed with feces. She recovered soon and returned to normal life at 10 days after initiation of clinical manifestations.


Gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after bile duct cancer surgery: a case report.

Lee HG, Hwang S, Joo YH, Cho YJ, Choi K - Korean J Hepatobiliary Pancreat Surg (2015)

Follow-up computed tomography finding showing disappearance of intraluminal radiopaque lesion (A) with mild distension and edematous wall thickening of the afferent bowel loop (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494082&req=5

Figure 2: Follow-up computed tomography finding showing disappearance of intraluminal radiopaque lesion (A) with mild distension and edematous wall thickening of the afferent bowel loop (B).
Mentions: Since her symptoms of abdominal discomfort were not severe and her gross appearance was not so seriously ill with normal vital signs, we decided to observe her closely for 1 or 2 days. On follow-up of liver function tests, hepatic dysfunction improved rapidly, thus implicating spontaneous passage of gallstone impaction. After 3 days of admission, unenhanced follow-up CT scan was performed, in which intraluminal radiopaque lesion disappeared with mild distension and edematous wall thickening of the afferent bowel loop (Fig. 2). These findings implicate the gallstone was spontaneous passed through the bowel and then removed with feces. She recovered soon and returned to normal life at 10 days after initiation of clinical manifestations.

Bottom Line: Since the clinical manifestation was improved, we decided to observe her closely.She recovered and returned to normal life after 10 days of initiation of clinical manifestations.We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
The diagnosis of gallstone ileus is occasionally challenging due to the variability of its presentation. We herein present a very rare case of gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after 10 years of bile duct cancer surgery. We describe the case of a 74-year-old Korean woman with obstructive jaundice, treated conservatively. She showed severely impaired liver function test and obstructive jaundice. The computed tomography (CT) scan led to a diagnosis of very rare type of gallstones ileus at the afferent jejunal loop. Since the clinical manifestation was improved, we decided to observe her closely. On the next follow-up CT scan, the gallstone disappeared with mild distension of the afferent bowel loop, implicating spontaneous passage of the gallstone. She recovered and returned to normal life after 10 days of initiation of clinical manifestations. We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size. The presence of narrow tract of intestine may facilitate the incidence of gallstone ileus. It appears to be the first report on this rare type of gallstone ileus inducing obstructive jaundice.

No MeSH data available.


Related in: MedlinePlus