PubMed · 3713027
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G M Kerimov, A A Akhmedov. 1986. [Cholelithic ileus].. https://pubmed.ncbi.nlm.nih.gov/3713027/
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OBJECTIVE: To compare three-dimensional sonography with two-dimensional sonography for diagnosis of gallbladder diseases. METHODS: Sixty-three patients with gallbladder diseases were examined with two- and three-dimensional sonography. The morphologic features presented on both modalities were analyzed, and the diagnostic accuracies of both modalities were evaluated and compared. RESULTS: Both two- and three-dimensional sonography facilitated correct diagnosis in all patients with gallstones. Three-dimensional sonography had no influence on the diagnosis of gallstones compared with two-dimensional sonography. Three-dimensional sonography showed the granular surfaces in 18 (81.8%) of 22 cases of polypoid lesions and the pedunculated fundus in 19 (86.4%) of 22, whereas two-dimensional sonography displayed them in 10 (45.5%) and 3 (13.6%) of 22, respectively (P < .05 and .001). Three- and two-dimensional sonography made correct differential diagnoses between non-neoplastic and neoplastic polyps in 20 (90.9%) and 12 (54.5%) of 22, respectively (P < .05). In gallbladder carcinoma, both three- and two-dimensional sonography accurately showed all the associated gallstones and intrahepatic bile duct dilatation. Two-dimensional sonography could not correctly define the locations of the lesions in 2 (28.6%) and tumor extension in 1 (14.3%) of 7 cases with pathologically proved gallbladder cancer, whereas three-dimensional sonography improved the diagnosis in these cases. CONCLUSIONS: Three-dimensional sonography adds no advantages for diagnosis of gallstones compared with two-dimensional sonography, but it is better than two-dimensional sonography for differential diagnosis of gallbladder polyps and may improve the localization and staging for gallbladder carcinoma; however, additional studies are needed for further determination.
Gallstone ileus is an uncommon disease of elderly patients who present with bowel obstruction. Mortality and severe complications are common, even in modern series, due to the comorbidities in the affected patient population. A number of less invasive ways to treat this disease are described. We report on a case where enterolithotomy was performed laparoscopically. The patient is a 60-year-old diabetic woman who presented with a bowel obstruction and pneumobilia on abdominal radiographs. She underwent exploratory laparoscopy using three reusable ports, an enterolithotomy, and her remaining bowel was examined. The benefits to a minimal access approach to this rare disorder are discussed. The ability to suture laparoscopically is emphasized.