Obstrucción colónica por cálculo / Colonic obstruction by gallstone

El íleo biliar es una rara complicación de la colelitiasis, que se caracteriza por presentar clínicamente una obstrucción intestinal mecánica intraluminal, secundaria a la impactación de un cálculo biliar en el tubo digestivo, debido a la existencia de una fístula bilio-entérica. El diagnóstico preoperatorio es difícil, ya que presenta síntomas y signos de obstrucción intestinal, los cuales son muy inespecíficos para sospechar un íleo biliar. El tratamiento de elección en el manejo del íleo biliar es el quirúrgico. Habitualmente se realiza una cirugía en dos tiempos, enterolitotomía como único gesto, sin embargo no hay una técnica quirúrgica definitiva estandarizada. Presentamos el caso de una paciente de 70 años que acude al Departamento de Urgencias con el diagnóstico clínico de obstrucción intestinal mecánica baja, de cuatro días de evolución, como consecuencia de un cálculo impactado en colon sigmoides.

Gallstone ileus is a rare complication of cholelithiasis, which is characterized by clinically presenting as an intraluminal mechanical intestinal obstruction secondary to the impaction of a gallstone in the digestive tract, due to the existence of a biliary-enteric fistula. The preoperative diagnosis is difficult, since it presents symptoms and signs of intestinal obstruction, which are very unspecific to suspect a Biliary Ileus. The treatment of choice in the management of gallstone ileus is surgery; usually is performed in two stages, whole lithotomy as the only gesture, however there is no standardized definitive surgical technique. We present the case of a 70-year-old patient, who attended the emergency department with the clinical diagnosis of low mechanical bowel obstruction, four days of evolution, as a result of a stone impacted in the sigmoid colon.

Hydatid disease of sigmoid colon

A 57 years old man presented with right loin pain and bouts of diarrhea. Plain x-ray of the abdomen revealed two calcified masses, one in the right hypochondrium and the other one in the pelvis, the diagnosis was that of calcified hydatid cysts [fig. 1]. Ultra sound examination revealed that the calcified mass in right hypochondrium was located in the liver, while the other pelvic mass was not related to any organ, it was located posterior and superior to the urinary bladder in relation to an air filled bowel loop [sigmoid colon]. The patient refused further investigations, he used an antidiarrheal locally grown plant named [shandagura]. Two weeks later he came back claiming that he had passed out a small hard piece with stools. Plain x-ray of abdomen showed that the pelvic calcified mass was broken and two pieces were been in the pelvic cavity [fig. 2]. One day later, the patient passed out another piece confirmed by plain way of the abdomen [fig. 3]. Another day passed and the last piece was expelled out [fig. 4]. The two calcified pieces that had passed out with stools are shown in [fig. 5]. Three months later the patient showed up for follow up, plain abdomen showed same findings of calcified mass in right hypochondrium and no pelvic calcifications. C.T. of the abdomen was done and the findings were consistent with calcified hepatic hydatid cyst [fig. 6]