Browsing by Author "Jiménez Espín, Galo Paúl"

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    “Abdomen agudo obstructivo secundario a íleo biliar”
    (Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Jiménez Espín, Galo Paúl; Pozo Mayorga, Fernando PatricioDr. Esp.
    Gallstone ileus is a serious condition due to not being diagnosed opportunely caused by the migration of a stone to the intestinal lumen through a biliary fistula being a rare cause of acute obstructive abdomen representing 1% to 4% of cases. Mortality rates of between 12 to 27% and morbidity of up to 50% have been described due to the critical state in which most of these patients are found (3). A 72-year-old male patient presents with generalized abdominal pain of great intensity without apparent cause of 5 days of evolution and nausea that reaches content vomiting. In pharmacy they prescribe paracetamol and hyoscine bromide without improvement. Physical examination: BP: 110/60 CF: 84X', BF: 20X', ° T: 36.5 °, O2: 84% Weight: 56kg. Patient awake, obeys verbal orders, semi-humid oral mucous membranes. Cardiovascular: rhythmic, normofonetic heart sounds, no murmurs are heard. Respiratory: decreased vesicular murmur, presence of rales in both lung bases. Abdomen: distended, painful to superficial and deep palpation Blumberg (+), increased tympanic percussion and decreased hydro-aerial sounds with metallic tone. Laboratory and imaging tests were requested: leukocytes13600, hemoglobin 21.4g / dL, hematocrit 75%, platelets 358000, neutrophils 88.3%, lymphocytes 6.6%. Urine: bacteria +++, pyocytes 15-18xc, red blood cells 1-2xc. Abdominal ultrasound: Gallbladder inside it is observed multiple lithiasic images, in addition to important dilation of bowel loops with fluid and peristalsis of fight. Abdominal x-ray: intestinal dilation and presence of hydro-aerial levels. Hydration, antibiotic, and laparotomy are started by finding the jejunum and ileum dilated with a +/- 5cm long by 3cm diameter, before which we decided to extract more primary raft of the ileum. He remains hospitalized for 7 days and evolves without complications.