Opportunities of Radiological Methods in Diagnosis of Cholecystitis Complicated Forms (Literature Review and Clinical Observations)

Abstract

Along with the increased incidence of gallstone disease (GSD) it was noted an enhancement of its severe complications. One of it is intestinal obstruction, resulting from internal biliodigestive fistula formation (Mirizzi syndrome, type II) and large gallstones migration through it into the small intestine lumen. Issues relating to causes identification, clinical aspects and treatment of gallstone obstructive intestinal obturation (biliary ileus) have been studied from the middle of the XVII century. However, up to date the disease common treatment and standardized diagnosis algorithm are not developed yet, especially in elderly people and in patients with comorbidity. Comprehensive and timely application of radiodiagnostics methods allows detailed assessing of biliary tract condition, selecting optimum treatment actions, including operative intervention volume, taking into account the risk of adverse outcomes and complications. The clinical observation of the 57 years old female patient with gallstone duodenal obstruction (Bouveret syndrome) with severe comorbidities was provided in the framework of the publication. The data of clinical and laboratory studies, the results analysis of multislice computed tomography, which allowed determining the level of the small intestine obstruction, changes in the thorax and abdomen organs in dynamics are represented in the report. The considered case emphasizes the necessity for early diagnosis of GSD, scheduled cholecystectomies performing in the presence of large gall-stones before complications onset.