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Brogna B, Ventola M, Blasio R, Colucci LJ, Gagliardi G, Bignardi E, Laporta A, Iovine L, Volpe M, Musto LA. Spontaneous resolution of gallstone ileus followed by imaging: A case report and a literature review. Radiol Case Rep 2023; 18:1175-1180. [PMID: 36660573 PMCID: PMC9842964 DOI: 10.1016/j.radcr.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 01/13/2023] Open
Abstract
Gallstone ileus (GI) is a rare cause of acute abdomen in an emergency setting and a rare complication of cholelithiasis in the elderly, with a female prevalence. Radiologists play a key role in the diagnosis and management of this condition and, with a multimodal approach, diagnostic accuracy usually increases. Spontaneous resolution of GI has previously been reported for stones smaller than 2 cm. Gallstones usually require surgical management; however, in patients with comorbidities and at high risk of surgical complications, a conservative approach may be considered. Herein, we report the case of an 84-year-old woman who came to the emergency department with an acute abdomen pain caused by a GI, with a 2.6 cm gallstone that was revealed on computed tomography and which was followed by diagnostic imaging with spontaneous resolution.
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Affiliation(s)
- Barbara Brogna
- Department of Emergency and Interventional Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy,Corresponding author.
| | - Marta Ventola
- Department of Medicine and Health Science, University of Study of Molise, “V. Tiberio”, Campobasso, 86100, Italy
| | - Roberta Blasio
- Department of Emergency and Interventional Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy
| | - Lorenzo Junior Colucci
- Medicine and Surgery in English, Precision Medicine Department, University of Study of Campania “Luigi Vanvitelli”, S. Andrea delle Dame, Via L. De Crecchio, 7, Napoli, 80138, Italy
| | - Giuliano Gagliardi
- Department of Emergency and Interventional Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy
| | - Elio Bignardi
- Radiology Unit, Cotugno Hospital, Naples, Via Quagliariello 54, Napoli, 80131, Italy
| | - Antonietta Laporta
- Department of Emergency and Interventional Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy
| | - Lorenzo Iovine
- Department of Emergency Surgery, San Giuseppe Moscati Hospital, Contrada Amoretta, Avellino, 83100, Italy
| | - Mena Volpe
- Department of Emergency and Interventional Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy
| | - Lanfranco Aquilino Musto
- Department of Emergency and Interventional Radiology, San Giuseppe Moscati Hospital, Contrada Amoretta, 83100 Avellino, Italy
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Gupta AK, Edwards B, Vega JA. The Tumbling Bullet: Subacute Intestinal Obstruction due to a Retained Bullet. Cureus 2020; 12:e9844. [PMID: 32953351 PMCID: PMC7497767 DOI: 10.7759/cureus.9844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022] Open
Abstract
A 29-year-old female presented with multiple gunshot wounds to the back and bilateral lower extremities. The patient underwent an exploratory laparotomy with small-bowel resection of two segments with primary stapled anastomosis and partial nephrectomy. The postoperative course showed prolonged intermittent bowel obstruction secondary to the bullet, which lodged in the distal ileum. The patient eventually passed the bullet; it, however, led to a delay in recovery.
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Affiliation(s)
- Anupam K Gupta
- Minimally Invasive Surgery, University of Miami Hospital, Miami, USA
| | - Blake Edwards
- General Surgery, Boca Raton Regional Hospital, Florida Atlantic University, Boca Raton, USA
| | - Jorge A Vega
- Trauma and Acute Care Surgery, St. Mary's Medical Center, Florida Atlantic University, West Palm Beach, USA
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3
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Unusual Presentation of Recurrent Gallstone Ileus: A Case Report and Literature Review. Case Rep Gastrointest Med 2019; 2019:8907068. [PMID: 31687227 PMCID: PMC6794980 DOI: 10.1155/2019/8907068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/22/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023] Open
Abstract
Background Gallstone ileus (GSI) is a rare form of small bowel obstruction (SBO) in patients with cholelithiasis, which is often poorly managed. Enhanced abdominal computed tomography (CT) with contrast is considered the most helpful diagnostic tool, as it is highly sensitive, specific, and accurate. We report an interesting case of recurrent GSI that was not detected by CT but diagnosed intraoperatively. Case Presentation A 49-year-old female with a previous history of choledocholithiasis and ERCP presented to the emergency department following episodes of sudden cramping, epigastric pain, and nausea. An abdominal CT revealed evidence of SBO with clear evidence of GSI and a cholecystoduodenal fistula. Laparoscopic exploration of the small bowel revealed a large, calcified 3.5 cm × 3 cm gallstone with evidence of pressure necrosis; segmental bowel resection with stapled anastomosis was performed and patient recovered appropriately after surgery. Cholecystectomy was not performed due to multiple co-morbidities and absence of gallbladder stones. However, she presented two months later with signs and symptoms of SBO. A repeat abdominal CT showed dilated bowel with no clear transition point. This was suspected to be due to adhesions. After an initial conservative treatment which produced mild improvement, laparotomy was performed which revealed a second large non-calcified gallstone and necrotic small bowel with a pocket of abscess. Conclusion The most sensitive diagnostic tool for GSI is enhanced abdominal CT but dilemma arises when GSI is not detected on CT. A high index of suspicion and further exploration are required in order not to miss other vital findings.
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Ploneda-Valencia C, Gallo-Morales M, Rinchon C, Navarro-Muñiz E, Bautista-López C, de la Cerda-Trujillo L, Rea-Azpeitia L, López-Lizarraga C. Gallstone ileus: An overview of the literature. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017. [DOI: 10.1016/j.rgmxen.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ploneda-Valencia CF, Gallo-Morales M, Rinchon C, Navarro-Muñiz E, Bautista-López CA, de la Cerda-Trujillo LF, Rea-Azpeitia LA, López-Lizarraga CR. Gallstone ileus: An overview of the literature. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:248-254. [PMID: 28433486 DOI: 10.1016/j.rgmx.2016.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/07/2016] [Accepted: 07/28/2016] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Gallstone ileus represents 4% of the causes of bowel obstruction in the general population, but increases to 25% in patients above the age of 65 years. Gallstone ileus does not present with unique symptoms, making diagnosis difficult. Its management is surgical, but there is no consensus as to which of the different surgical techniques is the procedure of choice. At present, there is no recent review of this pathology. AIM To conduct an up-to-date review of this disease. MATERIALS AND METHODS Articles published within the time frame of 2000 to 2014 were found utilizing the PUBMED, EMBASE, and Cochrane Library search engines with the terms "gallstone ileus" plus "review" and the following filters: "review", "full text", and "humans". RESULTS The results of this review showed that gallstone ileus etiology was due to intestinal obstruction from a gallstone that migrated into the intestinal lumen through a bilioenteric fistula. The presence of 2 of the 3 Rigler's triad signs was considered diagnostic. Abdominal tomography was the imaging study of choice for gallstone ileus diagnosis and the surgical procedures for management were enterolithotomy, one-stage surgery, and two-stage surgery. Enterolithotomy had lower morbidity and mortality than the other 2 procedures. CONCLUSIONS The aim of gallstone ileus treatment is to release the obstruction, which is done through enterolithotomy. It is the recommended technique for gallstone ileus management because of its lower morbidity and mortality, compared with the other techniques.
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Affiliation(s)
- C F Ploneda-Valencia
- Departamento de Cirugía General, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México.
| | - M Gallo-Morales
- Departamento de Cirugía General, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
| | - C Rinchon
- Escuela de Medicina y Odontología Schulich, Universidad de Western Ontario, London, Ontario, Canadá
| | - E Navarro-Muñiz
- Departamento de Cirugía General, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
| | - C A Bautista-López
- Departamento de Cirugía General, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
| | - L F de la Cerda-Trujillo
- Servicio de Investigación Clínica, Departamento de Cirugía, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
| | - L A Rea-Azpeitia
- Departamento de Cirugía General, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
| | - C R López-Lizarraga
- Departamento de Cirugía General, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Jalisco, México
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Takata H, Yoshida H, Hirakata A, Watanabe M, Uchida E, Uchida E. Recurrent Gallstone Ileus Successfully Treated with Conservative Therapy. J NIPPON MED SCH 2016; 82:300-3. [PMID: 26823035 DOI: 10.1272/jnms.82.300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Gallstone ileus is a rare complication of cholecystolithiasis, with the majority of cases requiring surgical treatment. In this paper, we describe a case of gallstone ileus that was successfully treated twice with conservative therapy. An 85-year-old woman was admitted to our hospital because of abdominal pain and vomiting. She had previously been treated with antibiotics for cholecystitis arising from 2 gallbladder stones. Computed tomography (CT) revealed that the small bowel was dilated and that 1 of the gallbladder stones had disappeared. In addition, a 28×22-mm calcified mass was found in the small-bowel lumen. We diagnosed gallstone ileus and performed nasogastric drainage for decompression. Follow-up CT revealed migration of the impacted stone, and symptoms had improved. However, 2 months after discharge, the patient's symptoms recurred. A CT scan revealed that the small bowel was again dilated and that the remaining gallstone had disappeared from the gallbladder. A 28×25-mm calcified mass was found in the small-bowel lumen. We diagnosed recurrent gallstone ileus. Because the gallstone was almost the same size as the previous one, we selected the same conservative decompression treatment. Fourteen days after the patient was admitted, the stone was evacuated with the feces. Although many cases of gallstone ileus require surgical treatment, spontaneous passage was achieved in this case. When treatment is chosen for gallstone ileus, the patient's presentation and clinical course must be considered.
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Affiliation(s)
- Hideyuki Takata
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
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De Giorgi A, Caranti A, Moro F, Parisi C, Molino C, Fabbian F, Manfredini R. Spontaneous Resolution of Gallstone Ileus with Giant Stone: A Case Report and Literature Review. J Am Geriatr Soc 2015; 63:1964-5. [PMID: 26389997 DOI: 10.1111/jgs.13635] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alfredo De Giorgi
- Department of Medicine, Azienda Ospedaliero-Universitaria, Ferrara, Italy
| | - Alberto Caranti
- Department of Medicine, Azienda Ospedaliero-Universitaria, Ferrara, Italy
| | - Federico Moro
- Department of Medicine, Azienda Ospedaliero-Universitaria, Ferrara, Italy
| | - Claudia Parisi
- Department of Medicine, Azienda Ospedaliero-Universitaria, Ferrara, Italy
| | - Christian Molino
- Department of Medicine, Azienda Ospedaliero-Universitaria, Ferrara, Italy
| | - Fabio Fabbian
- Department of Medicine, Azienda Ospedaliero-Universitaria, Ferrara, Italy
| | - Roberto Manfredini
- Department of Medicine, Azienda Ospedaliero-Universitaria, Ferrara, Italy
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Khan A, Flavin KE, Harris LS, Chaudhry MN, Reading N. Bowel hath no fury like a gallbladder inflamed. J Surg Case Rep 2014; 2014:rju028. [PMID: 24876462 PMCID: PMC3998213 DOI: 10.1093/jscr/rju028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Gallstone ileus is a well-established phenomenon in which a large gallstone leads to mechanical small bowel obstruction. This case, however, reports the novel finding of a patient presenting with suprapubic pain and guarding caused by paralytic ileus of the small bowel and a duodenal perforation secondary to a necrotic gallbladder. It highlights the importance of distinguishing between gallstone ileus and paralytic ileus and how the management of the two conditions differs. Furthermore, this article discusses how paralytic ileus caused by intra-abdominal inflammatory conditions such as cholecystitis can mask the typical clinical findings making the diagnosis difficult.
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Affiliation(s)
- Amad Khan
- Department of Surgery, Whipps Cross University Hospital NHS Trust, London, UK
| | | | - Lauren Sarah Harris
- Department of Surgery, Whipps Cross University Hospital NHS Trust, London, UK
| | | | - Nicholas Reading
- Department of Radiology, Whipps Cross University Hospital NHS Trust, London, UK
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Aslam J, Patel P, Odogwu S. A case of recurrent gallstone ileus: the fate of the residual gallstone remains unknown. BMJ Case Rep 2014; 2014:bcr-2013-203345. [PMID: 24748139 DOI: 10.1136/bcr-2013-203345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Gallstone ileus is a serious complication of cholelithiasis where mechanical small bowel obstruction occurs. The recurrence of gallstone ileus is rare. The 67-year-old woman in this case report had three known gallstones transit her small bowel with two causing obstruction and the third causing a 'tumbling phenomenon'. As we have an ageing population, and gallstone ileus has a higher incidence in the over 65 age group, associated with increased comorbidities and hence greater mortality rates, it is imperative to establish the best surgical intervention for it. This case report highlights the difference CT of the abdomen has made to the diagnosis of gallstone ileus and the pros and cons of the surgical management options.
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Affiliation(s)
- Jamil Aslam
- Department of Surgery, Walsall Manor Hospital, Walsall, UK
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Wong CS, Crotty JM, Naqvi SA. Pneumobilia: a case report and literature review on its surgical approaches. J Surg Tech Case Rep 2014; 5:27-31. [PMID: 24470847 PMCID: PMC3889000 DOI: 10.4103/2006-8808.118616] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Gallstones ileus is an uncommon cause but important cause of small bowel obstruction. The gallstone enters the intestinal lumen via a fistula located in the duodenum (cholecystoduodenal), or rarely, in the colon (cholecystocolonic) or stomach (cholecystogastric). This may result in large bowel or gastric outlet obstruction (Bouveret's Syndrome). Gallstone ileus affects the elderly females pre-dominantly and is associated with a high morbidity and mortality rate if diagnosis and urgent surgical intervention are delayed. In this paper, we report on the case of an elderly lady who presented with classical symptoms and signs of small bowel obstruction. She was subsequently diagnosed with gallstone ileus due to a large gallstones lodged in the intestinal lumen. We perform a literature review on this rare disease and discuss the two main surgical approaches in managing this condition. Gallstone ileus should be considered in the differential diagnosis of small bowel obstruction especially in elderly women who have no history of abdominal surgery or abdominal hernia. Early intervention is important because of the high mortality rate due to the poor general condition that often exists in this subgroup of patients. There is no general consensus on gold standard surgical approach in these cases but a two-stage procedure (either enterotomy alone or enterotomy and subsequent cholecystectomy) has been shown to be associated with lower mortality rates.
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Affiliation(s)
| | - James Maurice Crotty
- Department of Radiology, Limerick University Hospital, Limerick, Co. Limerick, Ireland
| | - Syed Altaf Naqvi
- Department of Surgery, Limerick University Hospital, Limerick, Co. Limerick, Ireland
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Resolution of gallstone ileus with spontaneous evacuation of gallstone: a case report. Indian J Surg 2013; 75:228-31. [PMID: 24426434 DOI: 10.1007/s12262-013-0818-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 01/15/2013] [Indexed: 10/27/2022] Open
Abstract
Gallstone ileus is an infrequent complication of cholelithiasis. The formation of a fistula between the gallbladder and duodenum may allow a gallstone to enter the gastrointestinal (GI) tract. Gallstone ileus generally occurs in the elderly patients and is associated with significant mortality. Spontaneous resolution of gallstone ileus after passage of gallstone per rectally, though rare, has been reported Farooq et al. (Emerg Radiol 4(6):421-423, 2007). We describe a 60-year-old woman who presented with a 3-day history of vomiting, pain, distension and constipation .Radiological investigations revealed dilatation of small bowel loops with multiple air fluid levels with a large lamellated radio-opaque density measuring 4.4 cm × 4 cm seen in the right iliac fossa. A possibility of gallstone ileus was kept. Because of co-morbid conditions (post-myocardial infarct with cardiac failure), surgery could not be done and patient was kept on conservative management. Three days later patient had sudden relief of her symptoms after passing a large calculus per rectally suggesting a spontaneous evacuation of gallstone. This case highlights the possibility of spontaneous resolution of gallstone ileus after the passage of gallstone. It has been reported in stones less than 2.5 cm. However, to the best of our knowledge, this is the first time in which a large stone measuring 4 cm × 3.8 cm passed spontaneously.
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Casasanta M, Mello M, Aghazarian S, Zapas J. Cholecystenteric Fistula: The Spectrum of Disease and Treatment Modalities. Am Surg 2012. [DOI: 10.1177/000313481207800510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marc Casasanta
- Department of Surgery Union Memorial Hospital Baltimore, Maryland
| | - Matthew Mello
- Department of Surgery Union Memorial Hospital Baltimore, Maryland
| | | | - John Zapas
- Department of Surgery Union Memorial Hospital Baltimore, Maryland; and Division of Surgical Oncology The Franklin Square Hospital Center Baltimore, Maryland
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Wysocki AP, Nath J, McGowan B. Spontaneous resolution (and other rarities) of gallstone ileus. ANZ J Surg 2009; 79:958-9. [DOI: 10.1111/j.1445-2197.2009.05162.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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