Íleo biliar / Biliary ileus

La litiasis vesicular es una entidad nosológica de frecuente ingreso y complicaciones, por lo cual el tratamiento médico-quirúrgico resulta frecuente en todos los servicios quirúrgicos. Una grave complicación de la litiasis vesicular la constituye el íleo biliar, entidad relativamente poco frecuente, caracterizada por un cuadro de obstrucción mecánica del intestino delgado o del colon, como consecuencia del paso de uno o más cálculos a través de una fístula biliodigestiva. Es una enfermedad caracteristica de la edad avanzada, con una edad promedio de 64 años y poco habitual antes de los 50 años. Se presenta el caso de una paciente del sexo femenino de 50 años de edad con un cuadro de obstrucción intestinal mecánica por cálculo biliar que ocluye la luz del íleon terminal, a nivel de los 40 cm proximales a la válvula de Bahuin, a quien no se le efectuó preoperatorio. Se realizó enterolitotomía y colecistectomía con fistulectomía y duodenorrafia. La paciente evolucionó favorablemente. Se concluye que es un caso característico de esta infrecuente afección y que el enfoque diagnóstico y terapéutico utilizado garantizó una evolución satisfactoria de la paciente

Vesicular lithiasis is a disease entity leads to frequent admissions and complications, thus, the medical-surgical treatment is usual in all surgical services. A severe complication of vesicular lithiasis is the infrequent biliary ileus characterized by a picture of mechanical obstruction of small bowel or the colon due to the passing of one or more calculi through a biliary-digestive fistula. It is disease characteristic of old age, with a mean age of 64 years and unusual before 50 years. This is the case of a female patient aged 50 with a picture of mechanical intestinal obstruction due to biliary calculus occluding the lumen of terminal ileum at the proximal 40 cm to Bahuin valve without preoperative diagnosis. An enterolithotomy and cholecystectomy were carried out with fistulectomy and duodenorrhaphy. Patient's course was favorable. We conclude that it a case characteristic of this infrequent affection and that the diagnostic and therapeutic approach used guaranteed a satisfactory course of the patient

The treatment of biliary calculus in the elderly

Authors studied the roles and outcomes of treatments for 98 elder patients with biliary calculus at St Paul Hospital. 16 patients were undergone emergency operation, and 43 patients were undergone elective operation, among them 9 patients received emergency treatments because of complications of biliary calculus. Conclusions: common treatment biliary calculus in the elderly was operation; however, the indication was given early and appropriately in case of patient was very old or too weak. In addition, evaluating patient’s situation before surgery by ASA’s method was very effective to choose correct treatment