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Karewsky syndrome: A case report and review of the literature

INTRODUCTION: Gallstone ileus can be a lethal disease, rarely suspected in the clinical scenario. It represents about 25% of all bowel obstruction cases in patients older than 65. There is a classification of gallstone ileus based on the onset time: acute, subacute and chronic (Karewsky syndrome). W...

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Autores principales: Ploneda-Valencia, César Felipe, Sainz-Escárrega, Victor Hugo, Gallo-Morales, Mariana, Navarro-Muñiz, Eliseo, Bautista-López, Carlos Alfredo, Valenzuela-Pérez, Jesús Alonso, López-Lizárraga, Carlos René
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486403/
https://www.ncbi.nlm.nih.gov/pubmed/26073917
http://dx.doi.org/10.1016/j.ijscr.2015.05.034
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author Ploneda-Valencia, César Felipe
Sainz-Escárrega, Victor Hugo
Gallo-Morales, Mariana
Navarro-Muñiz, Eliseo
Bautista-López, Carlos Alfredo
Valenzuela-Pérez, Jesús Alonso
López-Lizárraga, Carlos René
author_facet Ploneda-Valencia, César Felipe
Sainz-Escárrega, Victor Hugo
Gallo-Morales, Mariana
Navarro-Muñiz, Eliseo
Bautista-López, Carlos Alfredo
Valenzuela-Pérez, Jesús Alonso
López-Lizárraga, Carlos René
author_sort Ploneda-Valencia, César Felipe
collection PubMed
description INTRODUCTION: Gallstone ileus can be a lethal disease, rarely suspected in the clinical scenario. It represents about 25% of all bowel obstruction cases in patients older than 65. There is a classification of gallstone ileus based on the onset time: acute, subacute and chronic (Karewsky syndrome). We describe the first reported case of chronic gallstone ileus. CASE PRESENTATION: A 78-year-old female was admitted to the ER with a 15-day case of consistent bowel obstruction. The subject reported a five-year history of recurrent hospital admissions that resolved spontaneously after non-surgical management. Karewsky syndrome was diagnosed and managed with enterolithotomy. After five days of postoperative evolution the patient was discharged, and at six months follow up, no other hospital admission or relapse has been registered. DISCUSSION: The gallstone ileus diagnosis demands a higher clinical suspicion, there is no biochemical marker, and an abdominal CT is ideal for imaging-based diagnosis. There is no consensus on the optimal surgical approach. CONCLUSION: We describe the first case of Karewsky syndrome and a gastro-jejune and gastric-choledochus double fistula. We emphasize the importance of higher clinical suspicion for patients with bowel obstruction older than 65 years old and make evident that although there are not evidence-based guidelines for this treatment, enterolithotomy is a recommended approach.
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spelling pubmed-44864032015-07-06 Karewsky syndrome: A case report and review of the literature Ploneda-Valencia, César Felipe Sainz-Escárrega, Victor Hugo Gallo-Morales, Mariana Navarro-Muñiz, Eliseo Bautista-López, Carlos Alfredo Valenzuela-Pérez, Jesús Alonso López-Lizárraga, Carlos René Int J Surg Case Rep Case Report INTRODUCTION: Gallstone ileus can be a lethal disease, rarely suspected in the clinical scenario. It represents about 25% of all bowel obstruction cases in patients older than 65. There is a classification of gallstone ileus based on the onset time: acute, subacute and chronic (Karewsky syndrome). We describe the first reported case of chronic gallstone ileus. CASE PRESENTATION: A 78-year-old female was admitted to the ER with a 15-day case of consistent bowel obstruction. The subject reported a five-year history of recurrent hospital admissions that resolved spontaneously after non-surgical management. Karewsky syndrome was diagnosed and managed with enterolithotomy. After five days of postoperative evolution the patient was discharged, and at six months follow up, no other hospital admission or relapse has been registered. DISCUSSION: The gallstone ileus diagnosis demands a higher clinical suspicion, there is no biochemical marker, and an abdominal CT is ideal for imaging-based diagnosis. There is no consensus on the optimal surgical approach. CONCLUSION: We describe the first case of Karewsky syndrome and a gastro-jejune and gastric-choledochus double fistula. We emphasize the importance of higher clinical suspicion for patients with bowel obstruction older than 65 years old and make evident that although there are not evidence-based guidelines for this treatment, enterolithotomy is a recommended approach. Elsevier 2015-06-03 /pmc/articles/PMC4486403/ /pubmed/26073917 http://dx.doi.org/10.1016/j.ijscr.2015.05.034 Text en © 2015 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Ploneda-Valencia, César Felipe
Sainz-Escárrega, Victor Hugo
Gallo-Morales, Mariana
Navarro-Muñiz, Eliseo
Bautista-López, Carlos Alfredo
Valenzuela-Pérez, Jesús Alonso
López-Lizárraga, Carlos René
Karewsky syndrome: A case report and review of the literature
title Karewsky syndrome: A case report and review of the literature
title_full Karewsky syndrome: A case report and review of the literature
title_fullStr Karewsky syndrome: A case report and review of the literature
title_full_unstemmed Karewsky syndrome: A case report and review of the literature
title_short Karewsky syndrome: A case report and review of the literature
title_sort karewsky syndrome: a case report and review of the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486403/
https://www.ncbi.nlm.nih.gov/pubmed/26073917
http://dx.doi.org/10.1016/j.ijscr.2015.05.034
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