Gallstone ileus following endoscopic retrograde cholangiopancreatography and sphincterotomy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Gallstone ileus is a mechanical obstruction caused by the impaction of one or more gallstones within the lumen of any part of the gastrointestinal tract. Although the disorder is a rare cause of small bowel obstruction (1% to 2%), it has been reported to cause up to 25% of cases of non-strangulated small bowel obstruction in patients over 65 years of age.</p> <p>Case presentation</p> <p>We report a case of a 67-year-old woman who presented with gallstone ileus following endoscopic retrograde cholangiopancreatography and sphincterotomy for choledocholithiasis. She had a history of terminal ileum resection with ileocolic anastomosis for Crohn's disease. A 3 cm gallstone was found to be impacted just proximal to the previous ileocolic anastomosis. A second gallstone was found on digital examination of the proximal small bowel.</p> <p>Conclusion</p> <p>A gallstone may enter the gastrointestinal tract following endoscopic retrograde cholangiopancreatography and sphincterotomy and impact proximal to an anastomotic stricture as demonstrated here. The radiographic image of small bowel obstruction plus air in the biliary tree is a classic diagnostic finding. After stone extraction, the entire small bowel and colon should be digitally examined for further stones.</p

Development of a duodenal gallstone ileus with gastric outlet obstruction (Bouveret syndrome) four months after successful treatment of symptomatic gallstone disease with cholecystitis and cholangitis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cases of gallstone ileus account for 1% to 4% of all instances of mechanical bowel obstruction. The majority of obstructing gallstones are located in the terminal ileum. Less than 10% of impacted gallstones are located in the duodenum. A gastric outlet obstruction secondary to a gallstone ileus is known as Bouveret syndrome. Gallstones usually enter the bowel through a biliary enteral fistula. Little is known about the formation of such fistulae in the course of gallstone disease.</p> <p>Case presentation</p> <p>We report the case of a 72-year-old Caucasian woman born in Germany with a gastric outlet obstruction due to a gallstone ileus (Bouveret syndrome), with a large gallstone impacted in the third part of the duodenum. Diagnostic investigations of our patient included plain abdominal films, gastroscopy and abdominal computed tomography, which showed a biliary enteric fistula between the gallbladder and the duodenal bulb. Our patient was successfully treated by laparotomy, duodenotomy, extraction of the stone, cholecystectomy, and resection of the fistula in a one-stage surgical approach. Histopathological examination showed chronic and acute cholecystitis, with perforated ulceration of the duodenal wall and acute purulent inflammation of the surrounding fatty tissue. Four months prior to developing a gallstone ileus our patient had been hospitalized for cholecystitis, a large gallstone in the gallbladder, cholangitis and a small obstructing gallstone in the common biliary duct. She had been treated with endoscopic retrograde cholangiopancreatography, endoscopic biliary sphincterotomy, balloon extraction of the common biliary duct gallstone, and intravenous antibiotics. At the time of her first presentation, abdominal ultrasound and endoscopic examination (including esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography) had not shown any evidence of a biliary enteral fistula. In the four months preceding the gallstone ileus our patient had been asymptomatic.</p> <p>Conclusion</p> <p>In patients known to have gallstone disease presenting with symptoms of ileus, the differential diagnosis of a gallstone ileus should be considered even in the absence of preceding symptoms related to the gallbladder disease. Gallstones large enough to cause intestinal obstruction usually enter the bowel by a biliary enteral fistula. During the formation of such a fistula, patients can be asymptomatic.</p

MAGNETIC ORDER OF THE COMPOUND SERIES RE6(MnxFe1-x)23 (RE = Y, Gd)

La magnétisation et la susceptibilité des composés isostructuraux (structure Th6Mn23) de la composition RE6(MnxFe1-x)23(RE = Y, Gd) ont été déterminées de 4 °K à 1 200 °K. Les températures de Curie Tc de RE6Mn23 et RE6Fe23 varient entre 468 et 486 °K. Dans le cas de Y6(MnxFe1-x)23 pour x = 0,5 à 0,7 et à une température de 4 °K un ordre magnétique a pu être observé ; si Y est remplacé par Gd, Tc = 120 °K. Les courbes µ(x) où le nombre de magnétons de Bohr, µ, est déduit de l'aimantation) montrent des minima profonds. Les résultats peuvent être expliqué en supposant un ordre antiparallèle entre les moments Mn et Fe et un ordre parallèle des moments Gd aux moments Mn.The magnetization and the susceptibility of isostructural compounds (6Mn23-structure) of the composition RE6(MnxFe1-x)23(RE = Y, Gd) have been determined from 4 °K to 1 200 °K. The Curie-temperatures Tc of the RE6Mn23 and the RE6Mn23 compounds (RE = Y, Gd) are in the range from 468 °K to 486 °K. In the case ofY6(MnxFe1-x)23 at 4 °K for x = 0.5-0.7 no magnetic order at all is observed ; if Y is replaced by Gd, T c = 120 °K. Also the µ(x) curves show deep minima (the Bohr-magneton number µ is calculated from the magnetization). The results can be explained by assuming an antiparallel ordering of the Mn- and Fe-moments to each other and a parallel ordering of the Gd-moments to the Mn-moments