Sahsamanis G, Maltezos K, Dimas P, Tassos A, Mouchasiris C. Bowel obstruction and perforation due to a large gallstone. A case report.
Int J Surg Case Rep 2016;
26:193-6. [PMID:
27497941 PMCID:
PMC4975710 DOI:
10.1016/j.ijscr.2016.07.050]
[Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/08/2016] [Accepted: 07/28/2016] [Indexed: 12/13/2022] Open
Abstract
Gallstone obstruction is a rare clinical entity presenting usually in elderly patients and is associated with a medical history of biliary symptoms.
CT examination uncovered all findings consisting Rigler’s triad, thus air in the gall bladder, bowel obstruction and a gallstone inside the bowel lumen. It also identified a cholecystoduodenal fistula.
Rupture of the small bowel occurred intraoperatively, and a large 3.2 cm gallstone was located in the terminal ileum, which was recovered.
Post-surgical recovery was uneventful with no further report of obstruction symptoms at 6 month follow up.
Introduction
Gallstone bowel obstruction is a rare form of mechanical ileus usually presenting in elderly patients, and is associated with chronic or acute cholecystitis episodes.
Case presentation
We present the case of an 80 year old female with abdominal pain, inability to defecate and recurrent episodes of diarrhea for the past 8 months. CT examination uncovered a cholecystoduodenal fistula along with gas in the gall bladder and the presence of a ≥2 cm gallstone inside the small bowel lumen causing obstruction. Patient was admitted to the operating room, where a 3.2 cm gallstone was located in the terminal ileus. A rupture was found in the antimesenteric part of a discolored small bowel segment, approximately 60 cm from the ileocaecal valve, through which the gallstone was recovered. The bowel regained its peristalsis, and the rupture was debrided and sutured. Patient was discharged uneventfully on the 6th postoperative day.
Discussion
Gallstone ileus is caused due to the impaction of a gallstone inside the bowel lumen. It usually passes through a fistula connecting the gallstone with the gastrointestinal tract. It can present with nonspecific or acute abdominal symptoms. CT usually confirms the diagnosis, while there are a number of treatment options; conservative, minimal invasive and surgical. Our patient was successfully relieved of the obstruction through recovery of the gallstone using open surgery, with no repair of the fistula.
Conclussion
Although rare, gallstones must be suspected as a possible cause of bowel obstruction, especially in elderly patients reporting biliary symptoms.
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