Biliary colic intestinal obstruction

　　The cause of biliary colic intestinal obstruction is the entry of large gallstones into the intestines. The diameter of stones that can cause intestinal cavity obstruction is generally above 2.5 cm. Turner reported a case with a diameter of 17.7 cm. The following is a specific introduction to the causes of this disease:

　　1. Abnormal channels exist between the bile duct and gastrointestinal tract

　　This is the pathological basis of biliary colic intestinal obstruction. Common abnormal channels between the bile duct and gastrointestinal tract include: common bile duct-duodenal fistula, gallbladder-duodenal fistula, gallbladder-colon fistula, gallbladder-gastric fistula, common bile duct-duodenal fistula, etc., among which gallbladder-duodenal fistula accounts for about 3/4. Hu Guobin and others once treated a patient with gallbladder duct stones and found a huge fistula between the left hepatic duct and the stomach, through which stones could pass into the intestines.

　　2. Iatrogenic factors

　　After undergoing biliary-enteric internal drainage surgery for gallbladder duct stones, the purpose of internal drainage is to reconstruct a smooth bile drainage pathway. In essence, it is equivalent to an artificial biliary-enteric fistula, which facilitates the passage of stones and thus leads to biliary colic intestinal obstruction.

　　Biliary colic intestinal obstruction is caused by gallstones entering the intestines, leading to intestinal obstruction. It can generally be cured by surgery, with a good prognosis. Only a small number of patients in the late stage of the disease may develop complications such as intestinal torsion, intestinal strangulation, and intestinal perforation.

　　The clinical manifestations of biliary colic intestinal obstruction are acute or chronic, high or low, partial or complete intestinal obstruction, and the symptoms and signs are similar to those caused by mechanical intestinal obstruction due to other reasons. In the early stage of the disease, it is partial obstruction, with mild symptoms, manifested as paroxysmal abdominal colic, accompanied by nausea and vomiting. This is due to the blockage of the proximal large intestinal lumen by gallstones, which stimulates the intestine to produce strong peristalsis. As the gallstones descend, the obstruction level decreases, and the symptoms also change with the progression of the disease, such as the cessation of anal排气 and defecation, progressive abdominal distension, abdominal tenderness, board-like abdomen, and a few patients may have jaundice and gastrointestinal bleeding, etc. The changes in symptoms and signs with the progression of the disease are characteristic manifestations of this disease.

　　Regular meals (three meals a day) is the best way to prevent gallstones, because during fasting, the gallbladder is filled with bile, and the gallbladder mucosa absorbs water to make the bile thick, at this time, cholesterol/lecithin large bubbles are easy to form, the viscosity of bile increases, and finally gallstone precipitates. If you eat, when food enters the duodenum, gallbladder contraction hormone is secreted reactively, causing the gallbladder to contract. At this time, a large amount of thick and water-containing gallstone bile is excreted into the intestine. Therefore, it can prevent the formation of gallstones.

　　Biliary colic intestinal obstruction is caused by intestinal obstruction due to the entry of gallstones into the intestine. Generally, abdominal X-ray examination is required for this disease, and it has 4 characteristics:

　　1. Intestinal obstruction

　　Since most of the gallstones are not large and smooth, they can gradually move down the intestine, so the obstruction is mostly incomplete, and the obstruction points often change. However, the lower part of the small intestine and the ileocecal valve opening are often the obstruction points (Figure 1A), and the obstruction is mostly in the small intestine. The incidence of colonic obstruction in different literature is only 2% to 8%,

　　2. Gallbladder

　　Gaseous accumulation in the bile duct, with more bile duct gas accumulation, which can be a thick tube-like structure, or with small branches. Due to the presence of bile duct obstruction before the obstruction, the bile duct is usually thicker than normal and usually more relaxed than the Oddi sphincter. The gaseous accumulation in the bile duct caused by the introduction of ascaris lumbricoides or other reasons, such as intestinal fistula, biliary-enteric anastomosis, etc., appears larger for differentiation,

　　3. Intestinal gallstones

　　About 50% of gallstones can be visualized under X-rays, some are faintly visible, so about half of biliary colic intestinal obstruction only shows signs of intestinal obstruction and biliary gas accumulation without visible gallstones (Figure 1B),

　　Biliary colic intestinal obstruction refers to intestinal obstruction caused by gallstones. How should patients eat to promote faster recovery from the disease?

　　First, easy to eat

　　1. It is recommended to eat light and nutritious, liquid foods, such as congee, vegetable soup, lotus root starch, egg flower soup, and noodles.

　　2. Foods that are easy to digest and promote defecation. Such as vegetables: kelp, pork blood, carrots, etc.; fruits: hawthorn, pineapple, papaya, etc.; eating more fiber-rich foods, such as various vegetables, fruits, brown rice, whole grains, and beans, can help defecate, prevent constipation, stabilize blood sugar, and reduce blood cholesterol.

　　3. Eat foods rich in protein and iron, such as lean meat, fish and shrimp, animal blood, animal liver and kidney, egg yolk, soy products, as well as jujube, green vegetables, sesame paste, etc.

　　4. Eat processed or finely cooked foods to facilitate mastication and digestion. Eggs can be eaten 1-2 times a week. Dairy products and their products, cereal roots and tubers, meat, fish, beans, eggs, vegetables, fruits, and oils are the six major categories of food, which should be consumed in a diverse manner to fully obtain various nutrients.

　　5. Choose vegetable oils, and use cooking methods such as boiling, steaming, mixing, roasting, braising, pickling, and stewing as much as possible.

　　Secondly, avoid eating

　　1. Eat less starchy foods such as potatoes, taro, Vermicelli, noodles, sweet potatoes, etc.

　　2. Avoid high-fat foods such as fatty meat, fried foods, cakes, pastries, oil sticks, etc.

　　3. Do not eat hard and indigestible foods.

　　4. Avoid spicy and刺激性 seasonings such as chili, Sichuan pepper, curry powder, etc.

　　5. Avoid smoking, drinking, and coffee to prevent stimulation of the bile duct sphincter, causing spasms of the bile duct sphincter and making bile excretion difficult.

　　6. Foods that produce gas, such as milk and soy milk, as well as foods rich in rough fiber, such as celery, soybean sprouts, onions, etc., should not be consumed.

　　Biliary colic enteric obstruction caused by gallstones entering the intestinal tract is called biliary enteric obstruction. Once diagnosed, surgery should be performed as soon as possible to relieve obstruction. The following surgical methods are available:

　　1. Push the obstructive stones into the colon.

　　2. Incising the intestinal canal to remove stones, during the operation of incising the intestinal canal to remove stones, it is best to push the obstructive stones slightly towards the proximal dilated intestinal canal before incising the mesenteric margin, which is conducive to the healing of the intestinal wall incision.

　　3. During the operation of incising the intestinal canal to remove stones, it is best to push the obstructive stones slightly towards the proximal dilated intestinal canal before incising the mesenteric margin, which is conducive to the healing of the intestinal wall incision. Most people advocate that only simple incision of the intestinal canal to remove stones and relieve obstruction is sufficient. Rodriguez et al. reported that simultaneous treatment of biliary and internal fistula problems would not increase complications and mortality rate, as a few cases may be caused by multiple stones, so the entire gastrointestinal tract should be carefully explored during the operation.