Radical surgery for complicated cholelithiasis in elderly patients: three clinical cases
Abstract
Management of complicated cholelithiasis (gallstone disease) in elderly patients is often limited to the use of only minimally invasive interventions.
Case report. We report three clinical cases of gallstone disease complications in patients over 75 years old who had previously undergone minimally invasive surgery and who was refused radical surgical treatment due to comorbidity. In two patients, this led to the development of purulent cholangitis and multiple organ failure, which required emergency hospitalization. At the first stage, biliary drainage was performed; then the multidisciplinary team managed to stabilize the condition of the patient; at the second stage, biliodigestive anastomoses were formed through laparotomic access on a loop turned off by the Ru. Complete relief of symptoms was achieved and no relapse was observed.
In another case, cholecystoduodenal fistula with stone migration and complete obstruction of the small intestine was found during laparotomy in an asymptomatic patient hospitalized for elective surgery.
Discussion. Comorbidity should not be considered as an absolute contraindication to radical surgery of complicated cholelithiasis in elderly patients: gallstone disease complications in most cases exceed the risks of surgical intervention. Radical surgery of complicated gallstone disease in patients over 75 years old is possible in condition of patient management by a multidisciplinary team.
About the Authors
A. E. Kustov
Hospital for war veterans No. 2 of Moscow Healthcare Department; Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Alexey E. Kustov - Cand. of Sci. (Medicine), Head of the Department of Surgery, Hospital for war veterans No. 2 MHD; Assistant Professor, Department of General Surgery, Sechenov First MSMU.
168, Volgogradsky avenue, Moscow, 109472; 8/2, Trubetskaya str., Moscow, 119991
V. I. Khrupkin
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Valery I. Khrupkin - Dr. of Sci. (Medicine), Professor, Department of General Surgery.
8/2, Trubetskaya str., Moscow, 119991
I. V. Gorbacheva
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Irina V. Gorbacheva - Cand. of Sci. (Medicine), surgeon, Associate Professor, Department of General Surgery.
8/2, Trubetskaya str., Moscow, 119991, Tel.: +7 (926) 5980694
A. S. Vorotyntsev
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Alexander S. Vorotyntsev - Cand. of Sci. (Medicine), Associate Professor, Department of General Surgery.
8/2, Trubetskaya str., Moscow, 119991
A. Y. Emelyanov
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Andrey Y. Emelyanov - Cand. of Sci. (Medicine), Associate Professor, Department of General Surgery.
8/2, Trubetskaya str., Moscow, 119991
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