| Abstract | Ileus uzrokovan žučnim kamencem rijetka je komplikacija bilijarne bolesti definirana kao mehanička opstrukcija dijela gastrointestinalnog sustava žučnim konkrementom s najčešćom lokalizacijom u ileocekalnoj valvuli i/ili terminalnom ileumu. Obično se javlja u starijoj životnoj dobi, a sklonije su mu žene nego muškaraci te osobe s određenim pridruženim bolestima poput diabetesa mellitusa i/ili divertikularne bolesti kolona. Simptomi kao što su bol u abdomenu, nadutost, mučnina i/ili povraćanje, opstipacija ili proljev te opći simptomi poput blago povišene temperature i malaksalosti u prosjeku traju 4-8 dana prije javljanja liječniku. Radiološki na ovo stanje ukazuju tri karakteristična znaka koja uključuju pneumobiliju, distendirani abdomen i ektopični kamenac, tzv. Riglerova trijada. Od slikovnih metoda u dijagnostici prednost ima kompjutorizirana tomografija (CT) koja daje važne podatke o broju, veličini te mjestu impakcije konkrementa i razini intestinalne opstrukcije čime pomaže pri donošenju odluka o daljnjim terapijskim modalitetima. Pristup liječenju može biti neoperativan ili operativan, ovisno o razini opstrukcije, veličini konkrementa te općem stanju bolesnika. Od neoperativnih metoda koristi se endoskopska litotripsija i evakuacija konkrementa te endoskopska litotripsija udarnim valovima (ESWL). Operativni zahvat uključuje ekstrakciju konkrementa otvorenom ili laparoskopskom enterolitotomijom uz kolecistektomiju u istom aktu ili u odgođenoj operaciji. Ileus uzrokovan žučnim kamencem, iako rijetko stanje, svakako treba biti u diferencijalnoj dijagnozi intestinalne opstrukcije, posebice u onih bez prethodnih abdominalnih operacija, kako bi se pravovremeno postavila dijagnoza te provelo adekvatno liječenje. |
| Abstract (english) | Gallstone ileus is a rare complication of biliary disease defined as a mechanical obstruction of a part of the gastrointestinal system by a gallstone, with the most common localization in the ileocecal valve and/or terminal ileum. It usually occurs at an older age, and women are more prone to it than men and people with certain associated diseases such as diabetes mellitus and/or diverticular disease of the colon. Symptoms such as abdominal pain, bloating, nausea and/or vomiting, constipation or diarrhea, and general symptoms such as a slightly elevated temperature and malaise last on average 4-8 days before reporting to a doctor. Radiologically, this condition is indicated by three characteristic signs: pneumobilia, a distended abdomen, and an ectopic stone, the so-called Rigler's triad. Computerized tomography (CT) is the preferred diagnostic imaging method, which provides important data on the number, size, and location of impaction of concretions and the level of intestinal obstruction, which helps in making decisions about further therapeutic modalities. The approach to treatment can be non-operative or operative, depending on the level of obstruction, the size of the concretion, and the general condition of the patient. Endoscopic lithotripsy and evacuation of concretions and endoscopic shock wave lithotripsy (ESWL) have been described as non-operative methods. The operative procedure includes the extraction of concretions by open or laparoscopic enterolithotomy with cholecystectomy in the same act or a delayed operation. Gallstone ileus, although a rare condition, should definitely be taken into consideration in the differential diagnosis of intestinal obstruction, especially in those without previous abdominal operations, to make a timely diagnosis and provide adequate treatment. |
