[Ultrasonographic diagnosis of a biliary-digestive fistula with gallstone ileus]. / Sonographische Diagnose einer biliodigestiven Fistel mit Gallensteinileus.

HISTORY AND CLINICAL FINDINGS: A 72-year-old woman was admitted to the hospital with upper abdominal pain, nausea, vomiting, and obstipation. INVESTIGATIONS: Percutaneous ultrasound found aerobilia, a biliary-digestive fistula, and an ileus with gallstones within the small bowel. The findings were confirmed at computed tomography. TREATMENT AND COURSE: A gallstone ileus on the basis of a biliary-digestive fistula was diagnosed. The patient was treated by surgery and with antibiotics. CONCLUSION: This case report demonstrates that percutaneous ultrasonography should be used as the first imaging procedure in the diagnosis of acute abdominal pain. This procedure makes it possible to detect a gallstone ileus. It is important also to define various intestinal structures accurately.

[Bilateral genuine cholesteatoma--a case report]. / Bilaterales genuines Cholesteatom--eine Fallbeschreibung.

We report on a patient who has been in otorhinolaryngological treatment for more than 24 years owing to recurrent infra-auricular fistulation. Early hospital admissions were due to suspected abscess-forming parotitis or lymphadenitis. As far as could be discerned, no sonographical or radiological diagnostics were conducted. Complications in the sense of meningitis or labyrinthitis were not reported. In the case of the aforementioned patient a bilateral anomaly in the area of the external auditory canal went hand in hand with the development of a bilateral genuine cholesteatoma. The auriculae were configurated normally. Corrective radical surgery was conducted on both sides, first the left, then the right side. What seems remarkable in this context is the fact that despite a over two decades old cholesteatoma there was no erosion of the osseous boundaries of the eardrum towards the labyrinth and cochlea and the osseous cover of the canalis facialis. The patient was diagnosed with a high degree loss of hearing. It was not possible to derive reproductive acoustic potentials intraoperatively, which pointed to deafness. Whether this deafness was congenital or developed in the course of time based on a growing sensory hearing loss could not be ascertained.