Safra Taşı İleusu Değerlendirmesinde Radyolojik Görüntülemenin Klinik Faydası

Year 2019, , 353 - 358, 31.12.2019

Adnan Özdemir Yunus Yılmazsoy , Serdar Arslan , Faruk Pehlivanlı

https://doi.org/10.24938/kutfd.590975

Abstract

Amaç: Safra taşı
ileusu kolelitiazisin nadir bir komplikasyonudur.
Tekrarlayan kolesistit atakları sonucu gelişen kolesistoduodenal fistül yolu
ile safra kesesi taşının intestinal sisteme geçmesi sonucunda oluşur.
Çalışmamızın amacı merkezimizde safra taşı ileusu tanısı alan hastaların
görüntüleme bulgularını sunmaktır.

Gereç ve Yöntemler: Aralık 2016-
Ocak 2019 tarihleri arasında hastanemiz radyoloji birimine başvuran hastalardan
ultrasonografi tetkikinde safra kesesi taşı öyküsü olan hastaların dosyaları
retrospektif olarak incelendi. Bu hastalardan safra taşı ileusu tanısı alan
hastalar tespit edildi. Hastaların hastaneye geliş şikayetleri, yaşları,
cinsiyetleri, eşlik eden hastalıkları ve radyolojik görüntüleme bulguları ile
fistül lokalizasyonu, taşın boyutu, obstrüksiyon seviyeleri değerlendirildi.

Bulgular: Bilinen safra
taşı öyküsü olan 342’si (%35.7) erkek, 616’sı (%64.3) kadın toplam 958 hastadan
safra taşı ileusu tanısı alan 5 hasta tespit edildi. Hastaların 3’ü kadın (yaş
ortalaması 76.67±13.05/ yıl), 2’si erkek (yaş ortalaması 59±1.41 /yıl) idi. Hastaların
direkt grafilerinde ileus bulguları mevcuttu. Yapılan ultrasonografi tetkikinde
tüm hastalarda safra kesesi net olarak vizüalize edilemedi. Değerlendirilebilen
barsak segmentlerinde ileusu düşündürecek çap artışı tespit edildi. İleus
nedenine yönelik yapılan bilgisayarlı tomografide hastaların hepsinde
intrahepatik safra yollarında hava, kolesistoduedonal fistül, barsak lümeninde
taşlar ve bu seviye proksimalinde ileus ile uyumlu görünüm izlendi. Taşların
boyutları ortalama 26.2±16.3 mm (16-55 mm) idi.

Sonuç: Safra taşı ileusu intestinal obstrüksiyonun
nadir nedenlerinden biri olmakla birlikte intestinal obstrüksiyon bulguları ile
acile başvuran ileri yaş ve kolelitiazis
öyküsü olan hastalarda safra taşı ileusu mutlaka akla gelmelidir.

Keywords

Safra taşı ileusu, kolelityazis, kolesistoduodenal fistül, bilgisayarlı tomografi

CLINICAL UTILITY OF RADIOLOGICAL IMAGING IN THE EVALUATION OF GALLSTONE ILEUS

Abstract

Objective: Gallstone ileus is a rare complication
of cholelithiasis. It occurs as a result of the passage of bile stones into
intestinal system via bilioenteric fistulae, which are formed by recurrent
attacks of cholecystitis, and obstruction of the intestinal lumen. The
objective of our study was to discuss the imaging findings of gallstone ileus
among patients diagnosed at our center.

Material and Methods: Among patients that admitted to our
hospital’s radiology department between December 2016 and January 2019, the
medical records of those with a history of gall bladder stone detected on
ultrasonography were retrospectively evaluated. Among those, cases of gallstone
ileus were identified. Admission complaints, age, sex, comorbidities,
radiological imaging findings, fistula localization, stone size, and
obstruction level were recorded and analyzed.

Results: Among 958 patients with bile stones, 342
(35.7%) were male and 616 (64.3%) were female. Gallstone ileus was identified
in five patients. Three of them were female (mean age 76.67± 13.05 years) and 2
were male (mean
age 59±1.41 years). Ileus signs were detected on plain radiograms for
all patients. The gallbladders were not clearly visualized by ultrasonography
in any of patients with gallstone ileus. A diameter increase suggestive of
ileus was detected in visualizable intestinal segments. Computed tomography to
identify the cause of ileus revealed air in the bile ducts, cholecystoduodenal
fistula, stones in intestinal lumen, and an appearance consistent with ileus
proximal to that segment. The mean size of the stones was 26.20±16.3 mm (16-55
mm).

Conclusion:
Although gallstone ileus is a rare cause of
intestinal obstruction, it should be definitely remembered in the differential
diagnosis in patients with advanced age and a history of cholelithiasis who
present to the emergency department.

Keywords

Gallstone ileus, cholelithiasis, bilioenteric fistula, computed tomography

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