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- W2977899688 abstract "Purpose: Results: A 71 year old woman presented with a two week history of progressive epigastric abdominal pain, nausea and vomiting with eventual “coffee ground” emesis. She carried a number of comorbid conditions including obesity, diabetes, hypertension, hyperlipidemia, atrial fibrillation and systolic dysfunction. Physical examination on presentation was remarkable for right-sided abdominal pain, upper quadrant greater than lower. Laboratory evaluation revealed little information with no elevation in white blood cell count, normal metabolic parameters and normal liver function tests. CT scan was performed with an indication of right upper quadrant pain showing a large 3.8 cm×2.0 cm gallstone within a dilated, possibly intussuscepted duodenum. Also seen was air within the biliary tract and gallbladder indicating the likelihood of a chole-enteric fistula. Endoscopy was performed showing a large, darkly pigmented, occlusive stone in the third portion of the duodenum. A Holmium laser catheter was placed in an effort to fragment the stone without success. Exploratory laparotomy was performed for stone extraction. A firm inflammatory mass was seen in the right upper quadrant with considerable distortion of the anatomy. Multiple unsuccessful attempts were made to manually fracture the stone with eventual duodenotomy required for delivery. Conclusion: Gallstone ileus is an infrequent complication of cholelithiasis responsible for 1 to 4% of cases of mechanical obstruction in all comers, though has been noted as a cause of approximately 25% of non-strangulated bowel obstruction in patients older than 65. The most common site for gallstone impaction is the terminal ileum. Large stones such as this can impact immediately within the small bowel. Pericholecystic inflammation causes adhesions while pressure necrosis allows for eventual complete erosion into the duodenal lumen. Mortality remains high in this patient population at 15-18% thought most likely secondary to advanced age and concurrent medical comorbidity. Holmium:YAG laser therapy has been successfully reported in the literature. Definitive surgical therapy can consist of simple enterolithotomy, or more extensive procedure including simultaneous removal of the gallbladder and choleenteric fistula. It is important to note that surgical mortality with even the simple procedure approaches 10%." @default.
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- W2977899688 date "2009-10-01" @default.
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- W2977899688 title "Bouveretʼs Syndrome: A Case Report of Upper GI Bleeding" @default.
- W2977899688 doi "https://doi.org/10.14309/00000434-200910003-00664" @default.
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