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Ileo de cálculos biliares asociado con ictericia obstructiva e isquemia intestinal: un informe de caso
Juraj Kolak1, Ivan Romic1, Hrvoje Silovski1
1Department of Hepatobiliary Surgery and Organ Transplantation, University Hospital Center Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
Journal of surgical case reports
|August 25, 2025
Resumen
Este raro caso de íleo de cálculos biliares involucró un gran cálculo biliar que causó obstrucción del intestino delgado, ictericia e isquemia. La intervención quirúrgica eliminó con éxito las piedras y reparó el daño, lo que condujo a una buena recuperación del paciente.
Área de la Ciencia:
- Gastroenterología
- Cirugía abdominal
- Imágenes de diagnóstico
Sus antecedentes:
- El íleo de cálculos biliares generalmente causa obstrucción del intestino delgado debido a los cálculos biliares que migran desde la vesícula biliar a través del conducto biliar común (CBD).
- La ictericia obstructiva simultánea y la isquemia intestinal en el íleon de cálculos biliares representan una presentación clínica excepcionalmente rara.
- Las imágenes avanzadas, especialmente la tomografía computarizada (TC) del abdomen y la pelvis, son cruciales para el diagnóstico.
Objetivo del estudio:
- Para reportar un caso extremadamente raro de íleos de cálculos biliares que se presentan con ictericia obstructiva e isquemia intestinal.
- Para resaltar el enfoque diagnóstico y el manejo quirúrgico exitoso de esta condición compleja.
- Hacer hincapié en la importancia de estrategias quirúrgicas adaptadas en pacientes de edad avanzada con comorbilidades.
Principales métodos:
- Un estudio de caso de una paciente de 88 años con sospecha de íleos de cálculos biliares, ictericia obstructiva e isquemia intestinal.
- Imágenes de diagnóstico mediante tomografía computarizada (TC) del abdomen y la pelvis.
- Intervención quirúrgica que incluye colecistectomía, reparación de la pared duodenal, exploración del conducto biliar común (coledocotomía) con extracción de piedras y drenaje por tubo T.
Principales resultados:
- El paciente presentó un cálculo biliar de 3 cm en el yeyuno isquémico distal y otro cálculo en el CDB.
- El manejo quirúrgico urgente se realizó con éxito.
- El paciente fue dado de alta en el día postoperatorio 25 y se mantuvo en buen estado de salud un año después.
Conclusiones:
- El íleo de cálculos biliares con ictericia obstructiva y isquemia intestinal es una emergencia quirúrgica rara pero crítica.
- El diagnóstico rápido a través de la tomografía computarizada y la intervención quirúrgica adaptada son vitales para obtener resultados favorables.
- El tratamiento quirúrgico, incluso en pacientes de edad avanzada, puede conducir a una recuperación exitosa.
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