Íleo biliar como causa poco frecuente de abdomen agudo obstructivo, presentación de caso clínico

Abstract

Introduction: Gallstone ileus is an infrequent complication of cholelithiasis (0.3-0.5%) and it is also a cause ofmechanical obstruction of the small or large intestine, which is caused by the migration of a stone through abilioenteric fistula itself that is more frequently cholecystoduodenal (65-77%) and that, despite being able tolodge in any part of the path, it most commonly lodges in the terminal ileum due to its anatomical narrowness.Although its prevalence is low of only 1-4% of the total of mechanical obstructive intestinal pathologies, thispathology is found in older adult patients and women, these being 25% of the total cases of the same andpresents a mortality rate of 12- 27% and reaching a recurrence of up to 50% of the same, which is why itsdiagnostic suspicion is of vital importance, together with the importance of image diagnosis and finally itsinitial surgical treatment, which in turn is also controversial between a single-step surgery with a highermortality rate and a two-step surgery with less mortality than the previous one but with a higher rate ofpersistence of cholecystoenteric fistula, recurrence of pathology and also the risk of carcinogenesis. Objective: To carry out a bibliographic review on the clinical suspicion of gallstone ileus, as well as itssurgical management, and to exemplify it by presenting a clinical case. Material and methods: Descriptive, retrospective study, presentation of a clinical case in the "IESS LatacungaBasic Hospital", a case that was treated in the General Surgery service of the hospital. Results: Description of the clinical case: a 29-year-old female patient with a personal clinical history ofhypertriglyceridemia treated with gemfibrozil; cholelithiasis diagnosed without treatment; grade III obesity;allergies: does not refer; surgical history: does not refer. Gyneco-obstetric history of importance: Date of lastmenstruation on 05/20/2007, refers to the use of family planning based on norethisterone + ethinyl estradiol.Current disease: Patient reported that 24 hours before going to the consultation, he presented without apparentcause colic-type abdominal pain of moderate intensity, located in the epigastrium with diffuse radiation to theflanks, this pain was accompanied by nausea that reached vomiting on more than 20 occasions. at thebeginning of nutritional content, but later becoming bilious. Despite episodes of vomiting, abdominal pain didnot subside, and she did not present any other symptoms. At the time of going to the medical consultation, aphysical examination was performed that reported a globose abdomen at the expense o f adipose panniculuswithout scars, painful on superficial and deep palpation in the epigastrium and left hypochondrium withoutthe presence of visceromegaly and positive signs of peritoneal reaction. metallic airborne noises, increased intone and strength; Rectal examination was also performed where tonic sphincter, empty rectal ampoule,without masses and clean glove finger were found. Complementary imaging tests are performed whereRigler's Triad is identified, compatible with a gallstone ileus. Emergency surgical intervention is decided. Conclusions: Gallstone ileus is an important and infrequent cause of mechanical obstruction and itsknowledge by the surgeon is essential for a diagnosis as early as possible.Introducción: El íleo biliar es una complicación infrecuente de la colelitiasis y además es causa de obstrucción mecánica del intestino delgado o grueso, la cual es producida por la migración de un lito a través de una fístula bilioentérica misma que es más frecuentemente colecisto duodenal (65-77%) y, que, a pesar de poder alojarse en cualquier parte del trayecto, este muy comúnmente se aloja en el íleon terminal debido a su estrechez anatómica. Objetivo: Realizar una revisión bibliográfica sobre la sospecha clínica del íleo biliar, así como su manejo quirúrgico y ejemplificarlo mediante la presentación de un caso clínico. Material y métodos: Estudio descriptivo, retrospectivo, presentación de caso clínico en el “Hospital BásicoIESS Latacunga”, caso que fue tratado en el servicio de Cirugía General del hospital. Resultados: Paciente que 24 horas antes de acudir a consulta presentó sin causa aparente dolor abdominaltipo cólico de moderada intensidad, localizado en epigastrio con irradiación difusa a flancos, este dolor fueacompañado por náusea que llega al vómito en más de 20 ocasiones siendo al inicio de contenido alimenticio,pero posteriormente tornándose bilioso, también se realizó tacto rectal donde se encontró esfínter tónico,ampolla rectal vacía, sin masas y dedo de guante limpio, se realiza exámenes complementarios de imagendonde se identifica la Triada de Rigler, compatible con un íleo biliar. Se decide intervención quirúrgica deemergencia. Conclusiones: El íleo biliar es una causa importante e infrecuente de obstrucción mecánica y su conocimientopor parte del cirujano es indispensable para un diagnóstico lo más precoz posible