Jejunal perforation in gallstone ileus – a case series

<p>Abstract</p> <p>Introduction</p> <p>Gallstone ileus is an uncommon complication of cholelithiasis but an established cause of mechanical bowel obstruction in the elderly. Perforation of the small intestine proximal to the obstructing gallstone is rare, and only a handful of cases have been reported. We present two cases of perforation of the jejunum in gallstone ileus, and remarkably in one case, the gallstone ileus caused perforation of a jejunal diverticulum and is to the best of our knowledge the first such case to be described.</p> <p>Case presentations</p> <p><b>Case 1</b></p> <p>A 69 year old man presented with two days of vomiting and central abdominal pain. He underwent laparotomy for small bowel obstruction and was found to have a gallstone obstructing the mid-ileum. There was a 2 mm perforation in the anti-mesenteric border of the dilated proximal jejunum. The gallstone was removed and the perforated segment of jejunum was resected.</p> <p><b>Case 2</b></p> <p>A 68 year old man presented with a four day history of vomiting and central abdominal pain. Chest and abdominal radiography were unremarkable however a subsequent CT scan of the abdomen showed aerobilia. At laparotomy his distal ileum was found to be obstructed by an impacted gallstone and there was a perforated diverticulum on the mesenteric surface of the mid-jejunum. An enterolithotomy and resection of the perforated small bowel was performed.</p> <p>Conclusion</p> <p>Gallstone ileus remains a diagnostic challenge despite advances in imaging techniques, and pre-operative diagnosis is often delayed. Partly due to the elderly population it affects, gallstone ileus continues to have both high morbidity and mortality rates. On reviewing the literature, the most appropriate surgical intervention remains unclear.</p> <p>Jejunal perforation in gallstone ileus is extremely rare. The cases described illustrate two quite different causes of perforation complicating gallstone ileus. In the first case, perforation was probably due to pressure necrosis caused by the gallstone. The second case was complicated by the presence of a perforated jejunal diverticulum, which was likely to have been secondary to the increased intra-luminal pressure proximal to the obstructing gallstone.</p> <p>These cases should raise awareness of the complications associated with both gallstone ileus, and small bowel diverticula.</p

A rare case of a retroperitoneal enterogenous cyst with in-situ adenocarcinoma

<p>Abstract</p> <p>Background</p> <p>Retroperitoneal enterogenous cysts are uncommon and adenocarcinoma within such cysts is a rare complication.</p> <p>Case presentation</p> <p>We present the third described case of a retroperitoneal enterogenous cyst with adenocarcinomatous changes and only the second reported case whereby the cyst was not arising from any anatomical structure.</p> <p>Conclusion</p> <p>This case demonstrates the difficulties in making a diagnosis as well as the importance of a multi-disciplinary approach, and raises further questions regarding post-operative treatment with chemotherapy.</p

CT scan showing multiple dilated loops of small bowel with free fluid and air seen on the mesenteric border of the mid jejunum (arrow) suggesting perforation of the small bowel

<p><b>Copyright information:</b></p><p>Taken from "Jejunal perforation in gallstone ileus – a case series"</p><p>http://www.jmedicalcasereports.com/content/1/1/157</p><p>Journal of Medical Case Reports 2007;1():157-157.</p><p>Published online 28 Nov 2007</p><p>PMCID:PMC2222670.</p><p></p

Early postoperative outcomes following hepatic resection for benign liver disease in 79 consecutive patients

AbstractBackgroundLiver resection is an accepted treatment modality for malignant disease of the liver. However, because of its potential morbidity and mortality, the practice of liver resection in benign disease is more controversial. This study was designed to assess the early outcomes of 79 consecutive liver resections for benign disease over a 12-year period and compare these with early outcomes of 390 consecutive liver resections for metastatic colorectal cancer (MCRC) during the same period.MethodsConsecutive liver resections were carried out in a single hepatopancreatobiliary (HPB) centre between 1996 and 2008. Patient demographics and early outcomes were recorded. Statistical analyses were performed using spss (Version 15). P<0.05 was considered to be significant.ResultsThere was no difference in median age between the benign group vs. the MCRC group (P=0.181). However, there was a significant trend towards a lower ASA grade in the benign group (P<0.001). There was no difference in median blood loss (P=0.139) or hospital stay (P=0.262). Morbidity rates were 8.9% in the benign group and 20.5% in the MCRC group (P=0.002). The rate of serious complications was 1.3% in the benign group compared with 4.4% in the MCRC group (P=0.041). There were no postoperative deaths in the benign group and eight (2%) in the MCRC group (P=0.004).ConclusionsLiver resection for benign liver tumours can be undertaken with a mortality rate approaching zero and minimal morbidity in specialist HPB units