A COMBINATION OF TWO TYPES OF INTESTINAL OBSTRUCTION OF DIFFERENT ETIOLOGIES

Relevance. Chronic calculous cholecystitis can cause many complications. One of them is the formation of a cholecystoduodenal fistula, the migration of gallstones into the intestines, and gallstone obstruction, which is more commonly located in the ileum. Among all forms of acute intestinal obstruction, colonic obstruction accounts for 30-40%. The main cause of colonic obstruction is tumoral damage to the colon, which accounts for 93%. The mortality rate for acute intestinal obstruction varies widely (10–40 %) and depends on the type of obstruction, the speed of diagnosis, and adequate treatment. The combination of different types of intestinal obstruction occurring at different levels is an extremely rare clinical situation. Clinical observation. This article presents a rare clinical observation of a combination of two types of intestinal obstruction of different etiologies occurring at different levels of the digestive tract.

Case Description. A 69-year-old man was admitted to the surgical department of the clinic with symptoms of acute intestinal obstruction. A multispiral computed tomography scan revealed a cholecystoduodenal fistula and a foreign body in the ileum (a gallstone) with signs of obstruction and the formation of small intestinal obstruction. A laparotomy was performed, and an ileal obstruction caused by a gallstone was discovered. An obstructing tumor with exophytic growth was found in the lower third of the sigmoid colon. The colon is moderately dilated. A dense infiltrate is detected in the subhepatic space. It is decided to perform a minimum amount of intervention in the conditions of emergency care. A loop colostomy is removed in the left iliac area, fixed. The stone from the small intestine is moved to the colon and removed through the colostomy.

Based on the available modern literature, the authors have identified only one description of a combination of different types of intestinal obstruction at different levels.

Conclusion. The rare combination of two types of intestinal obstruction was diagnosed in a timely manner. The chosen treatment strategy allowed for the resolution of a severe complication of cholelithiasis and the continuation of the examination for cancer.

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